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DAMAGE INFORMATION REQUEST

State Form 54909 (R2 / 2-14)
INDIANA UTILITY REGULATORY COMMISSION – PIPELINE SAFETY DIVISION

Note: The person completing this form should only complete information known by that individual when completing the request.

Or mail to:
Indiana Utility Regulatory Commission
Pipeline Safety Division - Case Number
101 West Washington Street, 1500E
Indianapolis, IN 46204
Or fax to: 317-233-2410