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CERTIFICATE OF AWARD ...... .............014...Age.. ....... .................. _.. <br />Type of Aid <br />Name........ H291M................................................................ No{.�&O �A <br />. <br />....Address ........Tool.Aiv.er..Mehraska.................... County of....... .. <br />......... <br />Changesof Address.......................................................................................................................... <br />Original Grant $...17..61 ........................ Date ....... DeeembW ..11......19.3.9. <br />Amount of <br />Grant <br />Date <br />STATUS Amount of <br />(Mod., Susp., Cano., Roo.) Grant <br />Dat. <br />STATUS <br />(Mod., Susp., Canc., Roo.) <br />................................................................................................ X0.11...ats ®er........................... <br />Signature of Payee Director of Assistanoe and Cwelfare <br />