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EENHANCED NHANCED EENTERPRISE NTERPRISE ONEONEZZ   

  TTAX AX CCREDIT REDIT ROGRAMROGRAMPP      

Annual Tax Credit Application 

                    &  

          Instructions  

S SEND  ORIGINAL SIGNED AND NOTARIZED COPY TO THE ADDRESS BELOW 
  Back up documentation must be sent via email

  Missouri Department of Economic Development 
    BCS Business & Community Solutions
          Business Finance Team
     301 W. High Street, Room 720 
             P.O. Box 118 
     Jefferson City, MO  65102-0118 
    Phone: 573-526-0308 or 573-522-9062
            Fax: 573-522-4322 
     www.missouridevelopment.org 
     Email : dedfin@ded.mo.gov 



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Checklist for Applying for Tax Credits 
 (Include with Application Every Year Benefits are requested) 

Year 1 

          Annual Application for Tax Credits ;WůĞĂƐĞ ďĞ ƐƵƌĞ ƚŽ ŵĂŝů ƚŚĞ ŽƌŝŐŝŶĂů͘Ϳ

          Supplemental Information Form 

          New Employee & New Investment Calculation Forms - (Excel Format - can be saved on CD) 

          Itemized Investment List (Include Base Year & Year Filing)  - (Excel Format - can be saved on CD) 

          Current Employment Information (Include Base Year &Year Filing Employees &   Taxable Wages paid) 

          Copy of Health Benefits provided to Employees 

          Copy of Lease (and proof of payment if lease rate is calculated monthly) 
           If a Service Industry, please provide by % breakdown of sales revenue by state. Must be greater 
            than 51% from out of state to qualify.  

 YES            NO Did the business receive property tax abatement of at least 50% for the tax year applying? 

 YES            NO If leasing, did the property owner receive the property tax abatement for the tax year 
                   applying? 

YEARS     2 – 5 

          Annual Application for Tax Credits (Please be sure to mail the original notorized.)

          New Employee & New Investment Calculation Forms - (Excel Format - can be saved on CD) 

          Itemized Investment List (Year Filing) - (Excel Format - can be saved on CD) 

          Current Employment Information (Employee & Taxble Wages paid for Year Filing) 

          Copy of Health Benefits provided to Employees [if benefits have changed from previous year(s)]

          Proof of payment if lease rate is calculated monthly 
           
          If a Service Industry, please provide by % breakdown of sales revenue by state. Must be greater       ) 
         than 51% from out of state to qualify.

 YES            NO Did the business receive property tax abatement of at least 50% for the tax year applying? 

 YES            NO If leasing, did the property owner receive the property tax abatement for the tax year 
                   applying? 

If this application package contains any materials that the Company considers to be closed records pursuant to  
Section 620.014 RSMo, each page must be clearly marked as 'Confidential'  and the Company must provide written 
support that releasing the information would endanger the competitiveness of the business.



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                                          ENHANCED ENTERPRISE ZONE - ANNUAL APPLICATION FOR TAX CREDITS

Tax Period of Company               (Please specify if tax period is calendar or fiscal by entering the dates of your tax period)
              Year for tax credits to begin                                      Beginning                         Ending 
Calendar                                                    Fiscal Year 

Business Name                                                                                             Federal Tax ID (FEIN) 

Address of Project Facility                                                                               UI Account #

City                                County                            Zip Code (9 digit) 
                                                                                                          Missouri 

CONTACT INFORMATION           (PLEASE PROVIDE TWO PEOPLE THAT DIRECTLY DEAL WITH TAX CREDITS FOR YOUR BUSINESS     )
Business / Facility Contact                                                                               Title 

Address                                                City                                               State             Zip Code 

Telephone Number                              Fax Number                                  E-mail

Preparer Contact Person                                                                                   Title 

Address                                                City                                               State             Zip Code 

Telephone Number                              Fax Number                                  E-mail

OTHER FACILITY  DDRESSA     ES  ( ) (ATTACH ADDITIONAL SHEET IF NEEDED)
Headquarters Address (if different that project facility)             City                                State             Zip Code 

Other Missouri Facility Address                                       City                                Zip Code          UI Account # 

Other Missouri Facility Address                                       City                                Zip Code          UI Account # 

TYPE OF BUSINESS

     C Corp                  S Corp           LLC            Sole Proprietor         Partnership          Other ____________________ 
If the taxpayer is a Partnership, S-Corporation, or other entity with a flow through tax treatment, identify the names, social security numbers and
proportionate share of ownership of each beneficiary, partner or shareholder on the last day of the tax period.  Aggregate proportionate shares or 
percent of total ownership may not exceed 100%. Attach separate sheet if necessary. 
                    Name(s)                     й KǁŶĞƌƐŚŝƉ                                  Name(s)                      % Ownership

Per Section 285.530 RSMo, any business receiving must                   To access E-Verify website, go to: 
enroll in the     E-Verify Program.  The program is designed            https://e-verify.uscis.gov/enroll/ 
to provide employment status information to determine 
                                                                        Have you certified all new employees, through 
the eligibility of applicants for employment.  Currently an                                                                 YES        NO 
                                                                        E-Verify, are authorized to work in the U.S.?
employer’s participation in E-Verify is FREE.  



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                                                              CERTIFICATION 
I, the undersigned, acting on behalf of the Company named below, hereby certify and agree to the following: 
 The information submitted by the Company to DED in connection with the Project is true and correct and such information is consistent with 
  documents provided to lenders, other government programs, or investors.  The Company hereby authorizes DED to verify such information from any 
  source;
 Neither the Company nor any person identified in the application:
    a)      Has committed a felony, is currently under indictment for a felony, or is currently on parole or probation;
    b)      Is delinquent with respect to any non-protested federal, state or local taxes or fees;
    c)      Has filed (or is about to file) for bankruptcy, unless otherwise disclosed to DED; or
    d)      Has failed to fulfill any material obligation under any other state or federal program;
 There are no pending or threatened liens, judgments, or material litigation against the Company or any person identified on the application which is
  likely to have a material impact on the Company’s viability;
 Neither the operations of the Project itself nor the receipt of incentives for the Project would violate any existing agreement;
 The Company has obtained or is capable of obtaining all necessary federal, state and local permits and licenses for the Project;
 I certify that the applicant does NOT knowingly employ any person who is an unauthorized alien and that the applicant has complied with federal law
  (8 U.S.C. § 1324a) requiring the examination of an appropriate document or documents to verify that each individual is not an unauthorized alien.
 I certify that the applicant is enrolled and will participate in a federal work authorization program as defined in Section 285.525(6), RSMo., with 
  respect to employees working in connection with the activities that qualify applicant for this program.  I certify that the applicant will maintain and,
  upon request, provide the Department of Economic Development documentation demonstrating applicant’s participation in a federal work 
  authorization program with respect to employees working in connection with the activities that qualify applicant for this program.
 I certify that the Applicant shall include in any contract it enters with a subcontractor in connection with the activities that qualify applicant for the 
  program, an affirmative statement from the subcontractor that such subcontractor is not knowingly in violation of Section 285.530.1, RSMo, and 
  shall not be in violation during the length of the contract. In addition the Applicant will receive a sworn affidavit from the subcontractor under the 
  penalty of perjury, attesting that the subcontractor’s employees are lawfully present in the United States. I certify that the Applicant will maintain 
  and provide the Department of Economic Development and Department of Revenue access to documentation demonstrating compliance with this
  requirement.
 I understand that, pursuant to section 285.530.5, RSMo, a general contractor or subcontractor of any tier shall not be liable under section 285.525 to 
  285.550 when such general contractor or subcontractor contracts with its direct subcontractor  who violates section 285.530.1, if the contract
  binding the contractor and subcontractor affirmatively states that the direct subcontractor is not knowingly in violation of section 285.530.1 and shall 
  not henceforth be in such violation and the contractor or subcontractor receives a sworn affidavit under the penalty of perjury attesting to the fact 
  that the direct subcontractor’s employees are lawfully present in the United States.
 I understand that if the applicant is found to have employed an unauthorized alien, applicant maybe subject to penalties pursuant to Sections
  135.815, 285.025, and 285.535, RSMo.
 I understand that if the applicant is found to have employed an unauthorized alien in Missouri and did not, for that employee, examine the 
  document(s) required by federal law, the applicant shall be ineligible for any state-administered or subsidized tax credit, tax abatement or loan for a 
  period of five years following any such finding.
 I attest that I have read and understand the Enhanced Enterprise Zone Tax Credit Program guidelines.
 I hereby agree to allow representatives of the Department of Economic Development (DED), Department of Revenue, or either of their designated 
  representatives, access to the property and applicable records as may be necessary for the administration of this program. 
 I certify under penalties of perjury that the above statements and information contained in the application and attachments are complete, true, and 
  correct to the best of my knowledge and belief.
I certify that I am a Corporate Officer/Member of the Applicant and have the proper authority to execute this document on behalf of the Applicant and 
that I am authorized to make the statement of affirmation contained herein.  I also realize that failure to disclose material information regarding the 
Applicant, any owners or individuals engaged in the management of the Applicant, or other facts may result in criminal prosecution.
Applicant Signature             Print Name                              Title                               Date

STATE OF ____________________________) 
                                       SS. 
COUNTY OF_________________________________) 
On this _____day of ______________________in the year 20____ before me, _________________________________________, a 
Notary Public in and for said state, personally appeared ________________________________[name of Corporate Officer / 
Member), ________________________________ [Official Title],   ___________________________________ [Name of 
Corporation / Limited Liability Corporation], known to me to be the person who executed the within Agreement in behalf of said 
company and acknowledged to me that he or she executed the same for the purposes therein stated. 

__________________________________ Notary Public           _________________________________ My commission expires 



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ENHANCED ENTERPRISE  ONE   Z                           UPPLEMENTAL S                 NFORMATION I           ORM       F                  (YEAR  1 ONLY) 

Business Name                                                                                                        Tax Year  

Start Date the   Expansion,       Acquisition, or   
                                                                                                    Commencement Date:         
Replacement Occurred:             
The Start Date   is   the first day that construction or expansion         was                      The Commencement Date         is   the date the expansion,  
began.                                                                                              relocation,   or new facility became    operational.  
Facility NAICS code                                    Is the     company       owned   51%    or more   by women?                                  YES        NO 
Does the  company       pay 50%     or   more                                                                                  Days worked       
                                                     YES             NO        If so, what Percentage?                    % 
of the employee’s       health  benefits?                                                                                      before eligible?      
Describe the proposed       project    and / or     activity to be   conducted  at this   facility: 

Lease 
Is this facility leased   from    another    person(s)?                (If Yes: Attach  the Lease    Agreement)                                 Yes            No 
Lease Start   Date                                Base Lease         Rate   per  Month              $                      Length of   Lease (years)      
Purchase    Acquisition           
Was this  a   purchase of   an existing    business?                                                                                            YES            NO 
Was this  a   purchase of   an existing    building?                                                                                            YES            NO 
Was this  a   new construction         on an empty  lot?                                                                                        YES            NO 
Date title to   the acquired      property   was transferred 
Purchase price     paid   for   real property  (and  tangible        personal     property,    excluding inventory;      if          
applicable):                                                                                                                                $  
Replacement Facility             
Did you  or     a related taxpayer     previously operate         a facility   elsewhere   in Missouri   that was    closed                 
                                                                                                                                                    YES        NO 
as a   result of   this facility?      
If Yes:   
      Previous Location:          
      Why did   it   cease at   this location?      
      Date of   Closure:         
      Amount of   Investment in   use at former             facility at time   of closure:                    $ 
Were any      of   the employees      transferred   to the   new location?                           YES    NO       If YES, how   many? 
Were any      employees     dislocated     due to closing       the facility?                        YES    NO       If YES, how   many? 

If there are multiple facilities within the state – the business is required to complete a Multiple Worksite Report  
(MWR) - BLS 3020 for each quarter beginning with the Base Year for the duration of program benefits.

CONTACT INFORMATION FOR                          :                                       Marya Amos 
MWR   BLS         3020 (ACQUIRE AND SUBMIT)                                            MERIC QCEW Supervisor 
NAICS  CODE (           INQUIRIES AND ASSIGNMENT)                                        Missouri Department of Economic Development 
                                                                                         PO Box 3150 
Has the BLS 3020 been completed for each  
                                                                      YES   NO           Jefferson City, MO  65102 
Quarter for the Base Year of program benefits? 
                                                                                         Phone:  573-751-8914 
Has the BLS 3020 been completed for each                                                 Email:  amosm@states.bls.gov 
                                                                      YES   NO 
Quarter for Tax Year(s) being applied for? 



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                                            ENHANCED ENTERPRISE ZONE

                                   NEW INVESTMENT CALCULATION

Business Name                                        Tax Period

                           Call DED Incentive Specialist for Base Year Dates

Attach a Fixed Asset or Depreciation Schedule of all real & depreciable tangible property.  Do Not Include Inventory 
                       or Construction in Progress.  ATTACH Lease payments if claiming Lease credit

                                   New Business Facility Investment
                       Year Filing                             Base Year
T ax Year Ending                              B ase Year Ending
B ase Year T o tal         $       0.00-    1                               $                      -   
1                          $           -    2                               $                      -   
2                          $           -    3                               $                      -   
3                          $           -    4                               $                      -   
4                          $           -    5                               $                      -   
5                          $           -    6                               $                      -   
6                          $           -    7                               $                      -   
7                          $           -    8                               $                      -   
8                          $           -    9                               $                      -   
9                          $           -    10                              $                      -   
10                         $           -    11                              $                      -   
11                         $           -    12                              $                      -   
12                         $           -    13          Total               $                      0.00 -   
13          Lease  Credit  $       0.00-   
14          Previous Years $           -   
15          Total          $       0.00-             Lease Credit Calculation
                                            Monthly Lease Rate              $                      -   
            Investment Calculation          # months    _____ to _____                                      0
Cumulative Investment over                  Monthly Lease Rate              $                      -   
Base Year
                           $       0.00 -   # months    _____ to _____                                      0
Transferred Investment     $           -    Total Lease Payments            $                      0.00-   

New Investment                     0.00
                           $           -   



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ELIGIBLE PAYROLL 

Taxable Wages, as defined for Box 1 on the W2 by the IRS include: 
1.    Total wages, bonuses (including signing bonuses), prizes, and awards paid to employees during the year.
2.    Total noncash payments, including certain fringe benefits.
3.    Total tips reported by the employee to the employer (not allocated tips).
4.    Certain employee business expense reimbursements
5.    The cost of accident and health insurance premiums for 2% or more shareholder-employees paid by an S corporation.
6.    Taxable benefits from a section 125 (cafeteria) plan.
7.    Employee contributions to an Archer MSA.
8.    Employer contributions to an Archer MSA if includible in the income of the employee.
9.    Employer contributions for qualified long-term care services to the extent that such coverage is provided through a flexible
      spending or similar arrangement.
10. Taxable cost of group-term life insurance in excess of $50,000.
11. Unless excludable under Educational assistance programs, payments for non-job-related education expenses or for
      payments under a non-accountable plan. See Pub. 970.
12. The amount includible as wages because you paid your employee's share of social security and Medicare taxes. (If an
      employer also paid an employee's income tax withholding, they should treat the grossed-up amount of that withholding as
      supplemental wages and report those wages in boxes 1, 3, 5, and 7. No exceptions to this treatment apply to household or
      agricultural wages.)
13. Designated Roth contributions made under a section 401(k) plan or under a section 403(b) salary reduction agreement.
14.   Distributions to an employee or former employee from a nonqualified deferred compensation plan (including a rabbi trust)
      or a nongovernmental section 457(b) plan.
15. Amounts includible in income under section 457(f) because the amounts are no longer subject to a substantial risk of
      forfeiture.
16. Payments to statutory employees who are subject to social security and Medicare taxes but not subject to federal income
      tax withholding must be shown in box 1 as other compensation.
17. Cost of current insurance protection under a compensatory split-dollar life insurance arrangement.
18.   Employee contributions to a Health Savings Account (HSA).
19. Employer contributions to an HSA if includible in the income of the employee.
20. Amounts includible in income under a nonqualified deferred compensation plan because of section 409A.

Note: All other compensation, including certain scholarship and fellowship grants). Other compensation includes taxable amounts 
that you paid to your employee from which federal income tax was not withheld. You may show other compensation on a separate 
Form W-2. 



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                                                    ENHANCED ENTERPRISE ZONE
                                                                                                            NEW BUSINESS FACILITY EMPLOYEES
                                                    EMPLOYEE & PAYROLL CALCULATION                          COUNT ONLY FULL TIME EMPLOYEES
                                                                                                            Year Filing                                    Base Year
Business Name                                              Tax Year                                    Tax Year Ending                       Base Year Ending
Please provide an employee payroll summary sheet for the tax year being claimed AND the Base year                                0                                  0
(send base year data only in the first year).  A list of employees is also required with the following 
                                                                                                                                 0                                  0
data: Name (last, first) - Last 4 digits of SSN (or Employee ID) - Date Hired - Date Terminated - 
Position Title - Pay Rate (Salary/Hourly amounts) - Taxable Wages paid - FT or PT status - Accepted /                            0                                  0
Decline Health Insurance Benefits provided by the company.                                                                       0                                  0
                                                                                                                                 0                                  0
                       Call DED Incentive Specialist for Base Year                                                               0                                  0
ATTACH Employee Data to back up the numbers that are submitted on this form.                                                     0                                  0
                          Payroll Monthly Breakdown                                                                              0                                  0
Year Filing (full time payroll only)                Base Year (full time payroll only)                                           0                                  0
Tax Year Ending                                     Base Year Ending                                                             0                                  0
1                      $             -              1                $                            -                              0                                  0
2                      $             -              2                $                            -                              0                                  0
3                      $             -              3                $                            -         Total                00            Total                00
4                      $             -              4                $                            -    # of Months                             # of Months         
5                      $             -              5                $                            -      Average                0.00           Average             0.00
6                      $             -              6                $                            -         # of Jobs @ NOI Submission                              0
7                      $             -              7                $                            -         New Facility Employee Calculation
8                      $             -              8                $                            -    Difference between the Year filing average & Base year      0.00
9                      $             -              9                $                            -    average employee count.
                                                                                                                                                                   0.00
10                     $             -              10               $                            -    Decrease of the # of employees transferred or laid off 
11                     $             -              11               $                            -    from in-state facilities 
12                     $             -              12               $                            -               # of New Employees                               0.000.00
13               Total $  0-                        13     Total     $                            0-   # of employees located at all related facilities in 
                                                                                                       MO



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                                     INSTRUCTIONS

                             Call DED Incentive Specialist for Base Year Dates
Attach a Fixed Asset or Depreciation Schedule of all real & depreciable tangible property.  Do Not Include Inventory or 
                                         Construction in Progress.
                                 New Business Facility Investment
          Year Filing                                                         Base Year
     Tax Year Ending             3                            Base Year Ending              4
     Base Year Total       $             -                  1                 6↓            8↓
   1      5↓                     7↓                         2                          $                     -   
   2                       $             -                  3                          $                     -   
   3                       $             -                  4                          $                     -   
   4                       $             -                  5                          $                     -   
   5                       $             -                  6                          $                     -   
   6                       $             -                  7                          $                     -   
   7                       $             -                  8                          $                     -   
   8                       $             -                  9                          $                     -   
   9                       $             -                  10                         $                     -   
  10                       $             -                  11                         $                     -   
  11                       $             -                  12                         $                     -   
  12                       $             -                  13      Total              $                     -   
  13      Lease  Credit    $             -   
  14      Previous Years         9
  15      Total            $             -                          Lease Credit Calculation
                                                    Monthly Lease Rate                      10
          Investment Calculation                    # months        _____ to _____          11
Cumulative Investment over                          Monthly Lease Rate                      12
Base Year                  $             -          # months        _____ to _____          13
Transferred Investment           14                         Total Lease Payments       $
   New Investment          $

   References the 11 spaces below "this" cell. 
     These areas will fill automatically 

1    The name of the business filing for tax credit 
2    The tax period (either calendar or fiscal): show dates 
     The end of the tax period the business is filing the tax credit against. (E.g. for calendar year 2012 - 
3    the tax year ending would be 12/31/2012). 
4    Must call the DED Incentive Specialist for this date.  Refer to guidelines for specific definition 
5↓   Month of tax period.  If crossing years, use mm/yy format 
6↓   Month of base year.  If crossing years, use mm/yy format 
7↓   Total investment for this month 
8↓   Investment during this month for the base year 
9    Use during Years 2+ (Call Incentive Specialist for this total) 
10   Monthly lease rate paid 
11   Number of months this rate was paid 
12   If lease rate changed during tax period, enter new lease rate. 
13   Number of months new lease rate was paid 
     Any investment that was transferred from another facility to the facility of which the tax credits 
14   are being filed. 



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                                         ENHANCED ENTERPRISE ZONE
                                                                                                                              NEW BUSINESS FACILITY EMPLOYEES
                                         EMPLOYEE & PAYROLL CALCULATION                                                       COUNT ONLY FULL TIME EMPLOYEES
                                                                                                                      Year Filing                      Base Year
Business Name               1                   Tax Year                                         2                 Tax Year Ending 3            Base Year Ending       4
Please provide an employee payroll summary sheet for the tax year being claimed AND the Base year (send               5↓           6↓            7↓                    8↓
base year data only in the first year).  A list of employees is also required with the following data: Name (last, 
first) - Last 4 digits of SSN (or Employee ID) - Date Hired - Date Terminated - Position Title - Taxable Wages 
paid - FT or PT status - Accepted / Decline Health Insurance Benefits provided by the company.

                    Call DED Incentive Specialist for Base Year 
   ATTACH Employee Data to back up the numbers that are submitted on this form.
                       Payroll Monthly Breakdown
Year Filing (full time payroll only)          Base Year (full time payroll only)
Tax Year Ending          3               Base Year Ending                                        4
1             5↓         9↓                     7↓                                               10↓
2                   $                -                          $                                        -    
3                   $                -                          $                                        -            Total        0             Total                 0
4                   $                -                          $                                        -         # of Months     11            # of Months           12
5                   $                -                          $                                        -            Average      0.00          Average               0.00
6                   $                -                          $                                        -            # of Jobs @ NOI Submission                       0
7                   $                -                          $                                        -                     New Facility Employee Calculation
8                   $                -                          $                                        -         Difference between the Year filing average & Base 
9                   $                -                          $                                        -         year average employee count.
10                  $                -                          $                                        -         Decrease of the # of employees transferred or laid 
11                  $                -                          $                                        -         off from in-state facilities                        13
12                  $                -                          $                                        -                     # of New Employees
13            Total $                -          Total           $                                        -         # of employees located at all related facilities in 
                                                                                                                   MO                                                  14

                                                                   Reference Key 
                                   References the 11 spaces below "this" cell. 
                                     These areas will fill automatically 

                       1             The name of the business filing for tax credit 
                       2             The tax period (either calendar or fiscal): show dates 
                                     The end of the tax period the business is filing the tax credit against. (E.g. for 
                       3             calendar year 2012 - the tax year ending would be 12/31/2012). 
                                     Must call the DED Incentive Specialist for this date.  Refer to guidelines for specific 
                       4             definition 
                    5↓               Month of tax period.  If crossing years, use mm/yy format. 
                                     Number of full time employees working at the facility as of the last day of the 
                    6↓               month. 
                    7↓               Month of base year.  If crossing years, use mm/yy format 
                                     Number of full time employees working at the facility as of the last day of the month 
                    8↓               during the base year. 
                    9↓               Taxable payroll paid during this month (FT only) See eligible payroll definition on next page. 
                    10↓              Taxable payroll paid during this month for the base year (full time only)
                                     Number of months in the year filing (typically this will be 12; however, the first year 
                    11               and possibly the last year will be partial years. 
                    12               Number of months in the base year that have employees. 
                                     Number of decrease in employees in other related facilities within the state of 
                                     Missouri (Please refer to guidelines for definition of "related facility") 
                    13 
                    14               Total number of employees at all related facilities in the state of Missouri 






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