New York State Workers' Compensation Board Application for ...
STATE OF NEW YORK WORKERS' COMPENSATION BOARD BUREAU OF COMPLIANCE 100 BROADWAY ALBANY. NY 12241 -0005 THIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION. Attached is an application for a certificate of attestation of exemption from New York State Workers' Compensation and/or Disability Benefits insurance coverage. ................
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