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 290.140). 


My name is:

____________________________________________________



My current address is:

_________________________________

_________________________________

_________________________________



_______________________________________
	(MY SIGNATURE)