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Indiana Earth, Inc. Date; <br />10343 McKinley Hwy. WIO Number,rat° "r�'001 <br />Osceola, IN 46561 <br />Phone: 574-674-6488 <br />Fax: 574-674-6480 <br />EXTRA WORK JQB ORDER <br />Ordered By . _._r �v ..... <br />Company Authorizing Extra cork <br />L.ocafion: tot Name: �+ <br />Description of Extra Work: <br />I <br />w .... m "ry <br />I hearby acknowledge theork on the above work order was authorized to be <br />done, was completed satisfactory. By signing this work order and authorizing the <br />work to be done I am authorizing payment on the above work. <br />Signature� � � Company Date <br />r <br />�_ <br />...W� <br />Job -oremac for Indiana Earth, Inc. Date <br />