This government document is issued by Auditor of Public Accounts for use in Nebraska
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https://www.google.com/url?client=internal-element-cse&cx=003873714344695240192:etmsvl9wkhk&q=https://auditors.nebraska.gov/Audit_Info/Audit_Forms/2022_Misc_Waiver.pdf&sa=U&ved=2ahUKEwj_uqDJireGAxUPVkEAHSDUBBk4ChAWegQIBhAB&usg=AOvVaw3rdHwGDp0WKfLCNN6Zo-2T&arm=e&fexp=72519171,72519168