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Nsion request can be no more than six (6) months.) (SEE PAGE 2 OF THIS FORM FOR ALL OTHER CATEGORY 1 REQUEST.) January 1, 2006 Grant Services One North Capitol, Suite 600 Indianapolis, Indiana 46204-2288 Re: Grant Number: To Whom It May Concern: The purpose of this letter is to request that the State of Indiana, acting by and through Grant Services, grant a change of for the above referenced contract, which contract to the was approved by the State on . expiration date from The justification.

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