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Get Affidavit Of Exempt Status Under The Workers' Compensation Act

State under oath as follows: 1. 2. 3. 4. 5. 6. 7. 8. 9. I, (Name of individual) operating as (independent contractor s business name), have agreed to provide services to (Contractor) during calendar year . I have read, signed and attached the Exempt Status Fact Sheet and understand that an Independent Contractor is one who engages to perform certain services for another, according to.

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