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Get Maryland Officer Exclusion Form

Date Stamp - WCC Use Only WORKERS COMPENSATION COMMISSION 10 East Baltimore Street Baltimore Maryland 21202-1641 TEL 410 864-5100 or 1 800 492-0479 TTD MD Relay Service 1 800 735-2258 http //www. wcc.state. md. us EXCLUSION FORM Pursuant to the provisions of Labor Employment Article 9-206 of the Annotated Code of Maryland officers or members of a Farm Corporation Close Corporation Professional Corporation or Limited Liability Company are covered .

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