Save Missouri Hemp PAC

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Company name if Applicable. Put N/A if personal contribution

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Use your business address if its the one making the contribution.

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Contribution amount of Check or Wire Transfer Cash must be below $100.00

Employer (if > $100) Put N/A if below $100

Occupation (if > $100) Put N/A if below $100

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Signature to certify: I certify this contribution is from my own funds or a registered United States Business and not from a foreign national.

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