This government document is issued by Treasurer for use in Polk County, NE
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https://www.google.com/url?client=internal-element-cse&cx=003873714344695240192:it9xcpr5ese&q=https://polkcounty.nebraska.gov/sites/polkcounty.nebraska.gov/files/doc/Protest%2520Form%2520422_0.pdf&sa=U&ved=2ahUKEwjT1erejqjyAhWLmIsKHRuNAxkQFjAIegQIAhAB&usg=AOvVaw1vAA4NDSzJB2h8ztH3Xi6V