Request for a Letter of Dismissal
(also known as a "Service Letter")
under Missouri Statute 290.140

DATE:    

TO:    

Subj: Request for a letter of dismissal (service letter) under Missouri Statute 290.140

I am a former employee. Please provide me with
a Letter of Dismissal (also known as a "service letter")
in accordance with Missouri Statute 290.140 (RSMo Section 290.140).

My name is:    

My current address is:    

(MY SIGNATURE)