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Indiana Department of Insurance

IDOI > Producers/Agents > Municipality Set-Aside Program > Set-Aside Program Enrollment and Notification Set-Aside Program Enrollment and Notification


Name of Municipality


Contact Information
Name and Title of Contact Person


Address of Contact Person


Contact Person Phone Number
( -

Contact Person Email Address


Enforcement Authority Information
Name of Enforcement Authority


Address of Enforcement Authority


Enforcement Authority Phone Number
( -

Enforcement Authority Email Address


Enrollment Options
Please enroll this Municipality in the Set-Aside Program

Please amend our Information

Please remove this Municipality from the Set-Aside Program

   I certify that this request has been approved by
         adoption of an ordinance by the Municipality’s
         governing body.