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Get MD WCC IC-02 2010

Iness in and about the State of Maryland, and that on the date set forth below my signature and under the penalty of perjury, the following checked box represents my status as a covered employee. Check all that apply: I have elected to become a covered employee under Section § 9-227 of the Labor and Employment Article, and have submitted the requisite Inclusion form (IC-15R) with the Workers’ Compensation Commission. I have not elected to become a covered employee under Section § 9-227 of t.

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