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Please TYPE or PRINT IN INK 6B-1 Rev. 7-15-2013 State of Connecticut Workers Compensation Commission Date filed with WCC Coverage Election by Employees who are Members of a Partnership DO NOT SEND THIS FORM TO A DISTRICT OFFICE Send to WORKERS COMPENSATION COMMISSION 21 OAK STREET 4th FLOOR HARTFORD CT 06106 IF YOU WISH TO RECEIVE A DATE-STAMPED COPY OF THIS FORM SEND 2 COPIES of each form Pursuant to C.

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Keywords relevant to Form 6b

  • Pursuant
  • Statutes
  • revoke
  • excluded
  • elect
  • Provisions
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