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<br />Certification of <br />County Highway Superintendent <br /> <br />For Determining Incentive Payment <br /> <br />January 1,2004 to December 31,2004 <br /> <br />rrliis certifies tnat <br /> <br />DANIEL HOSTLER <br /> <br />(Name of Licell.seti Superintenaent) <br /> <br />lias senJed as tne County Jfign'Way Superintenaent of BALL <br /> <br />(County Warne) <br /> <br />from <br /> <br />JANUARY 1 <br />:Montn <br /> <br />} 2004 to <br /> <br />DECEMBER 31 <br />'Montfi <br /> <br />} 2004. <br /> <br />![)ate <br /> <br />![)ate <br /> <br />}l ttest: <br /> <br />2 <br />/""1. <br />" - ~J <br />(-- f11t:g::rflA~ <br /> <br />~~~r- <br /> <br />aQd ~ ~ <4! aQd <br /> <br />If you employed more than one licensed County Highway Superintendent during the <br />year, list the name and dates of service of each Superintendent. <br /> <br />aQd ~ aQd aQd aQd <br /> <br />Reference 39-2501 through 39-2505 Neb. Rev. Stat. <br /> <br />t\. <br /> <br /> <br />/' <br /> <br />"\ <br />Return the completed notificaflOn to: <br />Highway Local Liaison Coordinator <br />Government Affairs Division <br />Nebraska Department of Roads <br />PO Box 94759 <br />Lincoln NE 68509-4759 <br />