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Get Application For Industrial Homeworker's Certificate

ON FOR INDUSTRIAL HOMEWORKER S CERTIFICATE Submitted in accordance with the provisions of Chapter 308, Laws of 1941 (TYPE OR WRITE PLAINLY) 1. Name of Homeworker Last Name First Name Miss-Mrs.-Mr. 2. Home address Number Street City Floor and Apartment Number, or person with whom you live Age 3. Social Security Number I certify that the above information is correct and that no part of this work will be performed by anyone but myself and that I will work only in my home at the above a.

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