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Get NY C-105.31 2004-2024

ON OF THE STATE TO BRING EXECUTIVE OFFICERS UNDER THE COVERAGE OF THE NEW YORK WORKERS' COMPENSATION LAW. To: (Print nameName and address of insuranceof carrier here) (Print and Address Insurance Carrier Here) THIS ELECTION IS EFFECTIVE AS OF THE DATE FILED WITH THE INSURANCE CARRIER TAKE NOTICE that under the provisions of Sec.54, subd. 6, of the New York Workers' Compensation Law as amended, the municipal corporation or political subdivision of the State named below has elected to bring its .

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