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Get ( T-cap) Verification Form - State Of Indiana - In

D to complete the proposed rehabilitation activities as prescribed. Total estimated cost of all Land Rehabilitation Activities Total T-CAP Funds requested Landowner/Operator * Printed Name(s) Date Signature(s) Land Rehabilitation Plan assisting agent Printed Name Organization/Agency/Entity Signature Date Indiana State Department of Agriculture, Division of Soil Conservation verification Printed Name Signature Date * By signing this form, the landowner/operator is agreeing that.

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