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WORKERS' COMPENSATION EXEMPTION FORM City of Kansas
Employer Fed ID Reason for exemption withdrawal Workers Compensation - Exemption Social Security Account ID X No employees The undersigned employer hereby gives notice that said employer hereby withdraws election to accept the Missouri Compensation Law as specifically indicated above. Please submit a completed copy of Form A OR a copy of your Certificate of Insurance along with your Business License application and payment to the below address. Date Signature REF* MO-WC65B PLEASE SEND COMPLETED...Show details
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