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Get Gid-242-en Dec09 - Insurance And Safety Fire Commissioner

ga.gov 2 Martin Luther King Jr., Dr., Suite 708, West Tower, Atlanta, GA 30334 Phone: 404-656-7556 Fax: 770-344-5798 E-mail: TBrewster oci.ga.gov SPECIAL PROJECTS THIRD PARTY ADMINISTRATOR NOTICE OF EXEMPTION GID-242-EN DECO9 The following information shall be completed by an officer and provided at the time the exemption is claimed and on an annual basis (12/31) thereafter in accordance with O.C.G.A. 33-23-100 (2)(c). Administrator Name FEIN Street City State Zip Phone Em.

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