This government document is issued by Mississippi Public Universitites for use in Mississippi
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https://www.google.com/url?client=internal-element-cse&cx=009964295939582107825:2zypwxjak6y&q=http://www.mississippi.edu/rm/downloads/forms_instructions/general_liability_claim_form.pdf&sa=U&ved=2ahUKEwisz-iTiqSIAxWLhP0HHU18E8E4FBAWegQIBRAB&usg=AOvVaw1er9LxF95hoKD2hvYw3c1d&arm=e