Morgan Conservation District Chemical Reimbursement Form

Morgan Conservation District Chemical Reimbursement Form
In order to get reimbursed for your chemical, please fill out this form and attach your receipts and pictures of the treated area below. The information in this form allows us to benefit the area by getting more funding to treat more noxious weeds in the future. This is for agricultural application only and municipalities or government funded organizations may not receive funding. You may be contacted to have your treatment area mapped. Landowner is responsible for submitting reimbursement form and documentation, even if weeds were sprayed by a contractor. Reimbursement may take 90 days. Receipts must be between July 1,2025 and June 15, 2026
There will be a $200 cap to each landowner request for chemicals.
Name:*
Address:*
Phone:
Format: (000) 000-0000.
Email:*
example@example.com
Reimbursement Amount: (YOUR RECEIPTS MUST BE ATTACHED!)*
Attach receipts and pictures here:*

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Treatment Location:*
Chemical Used:*
Total Acres Treated:*
Total Hours Spent Spraying:*
Equipment Used to Spray:*
List the Noxious Weeds that you sprayed:*
Chemical Agreement
The Herbicide donated by Morgan Conservation District was used specifically for the State/County Noxious and designated Invasive Weeds. I ________________________________ accept all liability and agree to hold Morgan Conservation District harmless. Furthermore, I will follow all label directions and all State and Federal laws governing the use of herbicides. I accept all liability for any damages and agree to hold Morgan Conservation District harmless for any related claims.
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Morgan Conservation District Chemical Reimbursement Form

Chemical Agreement