Tennessee > Workers Compensation
Notice Of Withdrawal Of Exempt Employers Voluntary Election I-9 - Tennessee
| Notice Of Withdrawal Of Exempt Employers Voluntary Election Form. This is a Tennessee form and can be used in Workers Compensation . |
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FORM I-9 TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT Division of Workers Compensation Nashville, Tennessee 37243-0661 NOTICE OF WITHDRAWAL OF EXEMPT EMPLOYERS VOLUNTARY ELECTION Notice is hereby given that _____________________________________________________________ Firm Name __________________________________________________________________________________________ FEIN# StreetAddress __________________________________________________________________________________________ City State Zip wish to withdraw its voluntary election to come under the provisions of the Tennessee Workers Compensation Act. _______________________________________________ Signature _______________________________________________ Address _______________________________________________ Address Dated this __________________day of_________________________, 20________. LB-0289 (rev.8/99)
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