This government document is issued by Department of Agriculture for use in Nebraska
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https://www.google.com/url?client=internal-element-cse&cx=009749228257069337583:osd0etncay8&q=https://nda.nebraska.gov/fscp/wam/Artifact%2520Intake-form-2024.pdf&sa=U&ved=2ahUKEwjF25e02bSGAxW8gP0HHW3GBrU4KBAWegQIBxAB&usg=AOvVaw38gzoK6jsP5OQg_miKMwdg&arm=e&fexp=72519171,72519168