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DBPR EL-4502 Client Initiation or Termination Form STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Chapter 468. 2 Furnish a copy of this completed form to your workers compensation carrier AND the following Dept. of Revenue General Tax Administration Return and Revenue Processing 5050 West Tennessee Street Tallahassee FL 32399-0100 Effective Date 5/2011 Dept. of Financial Services Division of Workers Compensation 200 East Gai.

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