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Get MO WC-134 2012

Appeared Name of Affiant who, being duly sworn on this oath states as follows: 1. My name is . I am of legal age and sound mind, capable of making this affidavit, and personally acquainted with the facts herein stated. I understand that by submitting this affidavit to the city or county for an occupational or business license as a contractor in the construction industry, I am stating that my business is exempt from carrying workers’ compensation insurance coverage. 2. I am the sole proprietor.

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