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DUPLICATE <br />OLD AGE ASSISTANCE CERTIFICATE <br />No......... g- ........... <br />............................. Hall ....................... County, Nebraska <br />Name .......... JOhn..W..Coomes..... .................................................................................................... <br />.............. <br />Age ... 12........... Address .......Wood..R.v..4r,�Nebr.:......................................................... <br />Amount $..5.s 00 .................. Modified Amount $ ................................ $ ................................ <br />Date ........... ay...21.?......................19...36 <br />This is a true copy of Certificate originally <br />issued. <br />Neil C.Vandemoer <br />.................................................................................... <br />Director of Assistance • L <br />(signed) Irl D.Tolen <br />.................................................................................. <br />Director of Assistance <br />.................................................................................. <br />Signature of Applicant, Nest Friend or Guardian' <br />