Cost-Share Signup

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Landowner Information

Social Security / FEIN Number:	* Please enter your social security number or your FEIN number.
Telephone Number	* Enter your phone number including area code.
First Name:	*
Last Name:	*
Address:	* Enter your mailing address.
City:	*
State	*	- - Choose One - - Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zipcode:	*
E-Mail Address:	* This is necessary to receive confirmation that your application was received.
Multiple Landowner:		Yes No
Practice/Land Treatment	* Give a brief description of proposed treatment.
Land Identification:	* Enter the Legal Description/Tract number of proposed land.
I understand that this is an application for cost share funds and that as a condition of receiving these funds I have not and will not begin construction or installation of this practice prior to contract approval by the Kansas Department of Agriculture’s Division of Conservation and notification of this approval by the Morris County Conservation District. Any activity related to the completion of this project prior to this notification will cancel this application and the availability of these funds. I also understand that the expiration date of June 30th on the contract is a firm date and failure to complete the project by that date will cancel the contract.
Condition Agreement:	* You must agree with above statment in order to continue.	I Agree I Disagree
Signature:	* By entering your name you are stating that you are the above named landowner or his/her representative.
Select Today's Date	* Please select today's date.
Security Code	*