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D by the judge. SOCIAL SECuRITy NumbER mR. mRS. ADDRESS mISS FEDERAL ID NumbER ExhIbITOR S NAmE mS. COuNTy CODE Reset FIRST LADY S PIE CONTEST MISSOURI STATE FAIR ENTRIES 2503 W. 16TH ST., SEDALIA, MO 65301 FAX: (660) 827-8169 OR (660) 827-8160 E-MAIL: entryforms mda.mo.gov TITLE (ChECk ONE) Print CITy STATE DAyTImE TELEPhONE *E-mAIL ADDRESS zIP CODE bIRTh DATE (yOuTh ONLy) ExhIbITOR S SIgNATuRE Please accept these entries subject to the rules a.
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