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/EMPLOYMENT%2520APPLICATION.pdf&sa=U&ved=2ahUKEwjl6oSCkKjyAhUjhf0HHRMhDGc4FBAWMAl6BAgCEAE&usg=AOvVaw1ga6J4oXI8uLd6dF28gWgF