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<br />I <br /> <br />r" <br /> <br />............'....................................................l.'. <br />.. <br /> <br /> <br />,": <br />,-,",-, <br /> <br />i,~ll <br /> <br />J)epartment of the TreasUrY ~ Internal ,R~":Ue: ServJce <br /> <br /> <br />~'668 <br /> <br />".4, <br /> <br />I <br /> <br />(Rev: ~.mber1978)1 <br />District <br /> <br />.. <br /> <br />41 <br /> <br />U__.;J/.' <br />Qt~=~\tl!t"', <br />fwf. <br /> <br />\1 <br /> <br /> <br />;.................1 <br />-'.' <br /> <br />',1 <br /> <br />0iUi <br /> <br />" O'1...o6-a1 <br />I os..~ <br />I O).~ <br />! ........ Aft... AOA <br />IV~ <br />I <br />i <br /> <br />lIP 41...oot11.3G <br />, .. 1{ 061113G <br />!lIPi;....Q6m30 <br />. ... .t..flI:...L'\Li.trt'Wl <br />j ~ lOitr---,......,--. <br /> <br />I <br />, <br />I <br />i <br />! <br />I <br /> <br /> <br />~ <br />=1 <br /> <br />_,~...... I <br />. '1f4J.f'1~ I <br />------------ I <br />'~l '-"~ <br />~. <br />I <br />I <br />-l <br />.-L- M_ - .. <br /> <br />llO12 <br />ftU, <br />81D6 <br /> <br />I <br />I <br />-.t~ _ <br />1- <br /> <br />I <br />1- <br /> <br />':,~-.;:....: ~ <br /> <br />--.l~'~ <br /> <br />'. ..,."...c<-'- <br />;::.~-~~,~, . . ~ <br />.~~ <br /> <br />:~;;;;~~ <br /> <br />I <br />I <br />-r-. ..-...... <br /> <br />+ <br /> <br />-" -'-_ --_.1 <br />-l-~-' <br />t-.- .=--~~--- <br /> <br />I <br />Totall $ 4.925.21 <br /> <br />6lI801 <br /> <br />This certificate was P/1lP8Ied and signed 8t... ___.._ <br /> <br />Onata. Nebraska <br /> <br />...____.______. on this. <br /> <br />the ._. 31 ~. day of <br /> <br />,July .19 <br /> <br />84 <br /> <br /> <br />. ...----------; " ~-~-- ---'--Tfll1e' <br />c/fLtA;A/ <br /> <br />etnef, Special Procedures <br /> <br />rutt ecMtowf-..:icrmenta i;t nO( -..ntifl/ to tI.. v.hidU)< of HOftc. ot <br /> <br />Part 3 - To be used for recording purposes <br /> <br />Form 688 (Rev. IH8) <br /> <br />~ <br /> <br />L <br /> <br />-..J <br /> <br />I <br />L.. <br />