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INSTRUCTIONS: If not filing electronically, submit one original application for the corporation along with an Executive. Form 509 and Form 513.509, Application for Executive Officer's Declaration - OCR, LIBC-509. INSTRUCTIONS: Submit one original Application for the corporation along with an Executive Officer's. USE FOR ONE-PERSON CORPORATION. I,. , certify that I am the sole executive officer of the above-named corporation; that I have been since. Application and Declaration to your insurance carrier. 1. The application for exemption is PALIBC 509. It is widely available on the internet. An executive officer of the corporation must complete and sign this form.