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* 1. Did you buy groceries or gas today?

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* 2. How much did you pay?

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* 3. Add a picture of your receipt! (optional)

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* 4. Have you struggled with the cost of living the past few months?

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* 5. Do you want Dan Sullivan to do something about it?

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* 6. Do you have any feedback for Dan Sullivan?

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* 8. What is your name?

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* 9. Do we have permission to use your first name and your responses to this form?

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