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Get TN LB-0090 2010

243-1002 NOTICE OF CORPORATE OFFICER TO EMPLOYER OF ELECTION NOT TO ACCEPT PROVISIONS OF “WORKERS’ COMPENSATION ACT” OF TENNESSEE. INSTRUCTIONS: File an original, a photocopy of the completed original and a self-addressed stamped envelope (approved copy will be returned). The form must be complete, legible and notarized. If any information is missing, the form will be returned and will prolong the effective date until form is received complete. The effective date is 30 days after approved.

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