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Get PA LIBC-513 2018-2024

Nal declaration for submission with the Corporation’s Application for Executive Officer Exception. The total ownership interest of all declarations combined must equal 100 percent. I, the below named Executive Officer, do hereby knowingly and voluntarily elect not to be an employee of the below named corporation for purposes of the Pennsylvania Workers’ Compensation Act, and waive any and all benefits and rights which I might be entitled under the Pennsylvania Workers’ Compensation Act (77.

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