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STATEMENT IN LIEU OF RECEIPT For MLH Hawaii Foundation I the undersigned hereby state that I lost the receipt and state that I made the following payment Date of purchase Name of Payee Description of item purchased Purpose of purchase Amount to the effect that its representations are true as far as the undersigned knows or is informed. Signature of Undersigned Print name of Undersigned Date APPROVAL BY THE BOARD OF DIRECTORS OF MLH HAWAII FOUNDATION The Board of Directors of MLH Hawaii...
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