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Get IN WCE-1 2009

Reset Form WCE-1 APPLICATION FOR WORKER S COMPENSATION CLEARANCE CERTIFICATE State Form 45899 R6 / 12-09 Indiana Department of Revenue / Worker s Compensation Board of Indiana INSTRUCTIONS Please type or print. Payment must be made using a money order or certified check. FOR STATE USE ONLY A 20. 00 non-refundable filing fee is required. 5. 00 Department of Revenue filing fee paid Date issued month day year 15. 00 Worker s Compensation Board filin.

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