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2. I would like to request the following form(s)*

   Please click at least one of the following options

   1. Medical Statement for Consideration of Care giver or Care Receiver Assistance
   2. Medical Hardship Temporary Use Permit Application
   3. Authorization for Individuals
   4. Authorization for LLC
   5. Authorization for Corporation
   6. Agricultural Exemption Application
4. Please provide email you want form(s) sent to.*
6. Name (Not Required)
8. Name of Business if Applicable (Not Required)
10. Address1, City, State, Zip (Not Required)
12. Please allow 24 business hours to receive a response.
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13. 1. Receive an email copy of this form.
14. Email address

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