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Get North Carolina Self Insurance Ib 43 Form

Gross Premium Tax Return Self-Insured Workers Compensation Corporation IB-43 Web 1-15 North Carolina Department of Revenue DOR Use Only Application Beginning for Period MM-DD-YY Ending MM-DD-YY Legal Name First 35 Characters USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS Mailing Address City State Name of Contact Person Zip Code Phone Number Federal Employer ID Number State of Domicile Fill in circle if applicable Payment has been made through ele.

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