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7/8/2017 6:47:29 PM
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DUPLICATE <br />OLD AGE ASSISTANCE CERTIFICATE <br />No....' 8..222. ��................ <br />..............................H 1 ....................... County, Nebraska <br />Name ....Henry ... Herne <br />................................................................................................................................ <br />Age... . �.......... Address ........ 1602 W. John, Grand Island, Nebr. <br />Amount $..15..00 ............... Modified Amount $ ................................ $ ................................ <br />Date .............. KIW... I,s..................... 19 ... 36 <br />This is a true copy of Certificate originally <br />issued. <br />Neil C.Vandemoer <br />...........................................................................I........ <br />IL Director of Assistance SL <br />(Signed} Irl.. D.Tolen.. <br />......................... <br />Director of Assistance <br />................................................................................. <br />Signature of Applicant, Next Friend or Guardian <br />
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