INDIANA OPERATING FACILITY LISTING
Please make corrections, if this information has changed Date:
Location # Headquarters: Name City Bushel Capacity
Facilities: 1). 2). 3). 4). 5). 6). 7). 8). 9). 10).
TOTAL BUSHEL CAPACITY:
FORMAL CERTIFICATION I hereby certify that the information provided herein is true and complete, that the facility/facilities are suitable for the storage of grain under the provisions of the Indiana Grain Buyers and Warehouse Licensing and Bonding Law, IC 26-3-7, as amended.
Typed or printed name: Title: Signature: Date: