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APPLICATION SENIOR FARMERS' MARKET NUTRITION PROGRAM State Form 53250 (R2 / 12-09) Indiana State Department of Health INSTRUCTIONS: 1. Fill out all blocks. This application will be returned to you
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First name - state refers to the field in a form or document that requires the individual's first name and their current state of residence.
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Anyone who is filling out a form or document that requires personal information may be required to provide their first name and state of residence.
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