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CERTIFICATE OF AWARD <br />..... Old ... Age...Aasis.tante................................ <br />Type of Aid <br />Name........ . W.sT. ohns.o 1..................................................................... No ........... &.91A......... <br />Address..l.516... W.est... .7j. rd...St.,....Gr.s n&...la.i.anCounty of........ al .................... <br />Changesof Address.......................................................................................................................... <br />.................................................................................................................................................................. <br />Original Grant $..27..40 ......................... Date ........ .blarrh... 1, 19.... <br />Amount of <br />Grant <br />Data <br />STATUS Amount of <br />(Mod., Snap., Cane., Roo.) Grant <br />Data <br />STATUS <br />(Mod., Sump., Cane., Rao.) <br />"zM <br />................................................................................................ Feil....C..yandemo.er......... ...' <br />r Signature of Payee Director of Assistance and CMU Walfara 8140 <br />