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In re Black Farmers Discrimination Litigation CLASS ACTION CLAIM FORM Civil Action No. 1 08-mc-0511 PLF For questions regarding this Claim Form call toll-free at 1-877-810-8110 or email questions blackfarmercase. I USDA/FSA Account Number Loan Number Year Loan Obtained USDA or FSA County Office Where Loan Outstanding Loan Balance IF YOU ANSWERED YES TO QUESTION 7H YOU MUST ALSO COMPLETE AN AUTHORIZATION TO DISCLOSE DEBT INFORMATION FORM WHICH CAN.

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