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MARIJUANA PROGRAM PATIENT ATTESTATION

MARIJUANA PROGRAM PATIENT ATTESTATION I, _____ , attest that: I will not divert MARIJUANA to any individual who or entity that is not allowed to possess MARIJUANA pursuant Title 36, Chapter and that the information provided in the application is true and correct. _____ _____ Signature Date Signed

MARIJUANA PROGRAM PATIENT ATTESTATION. I, _____ , attest that: I will not divert marijuana to any individual who or entity that is not

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  Programs, Marijuana, Marijuana program

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Transcription of MARIJUANA PROGRAM PATIENT ATTESTATION

1 MARIJUANA PROGRAM PATIENT ATTESTATION I, _____ , attest that: I will not divert MARIJUANA to any individual who or entity that is not allowed to possess MARIJUANA pursuant Title 36, Chapter and that the information provided in the application is true and correct. _____ _____ Signature Date Signed


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