Affidavit Of Exemption From Kentucky Workers Compensation Act Individual | Pdf Fpdf Doc Docx | Kentucky

 Kentucky   Workers Comp 
Affidavit Of Exemption From Kentucky Workers Compensation Act Individual | Pdf Fpdf Doc Docx | Kentucky

Last updated: 10/3/2023

Affidavit Of Exemption From Kentucky Workers Compensation Act Individual

Start Your Free Trial $ 13.99
200 Ratings
What you get:
  • Instant access to fillable Microsoft Word or PDF forms.
  • Minimize the risk of using outdated forms and eliminate rejected fillings.
  • Largest forms database in the USA with more than 80,000 federal, state and agency forms.
  • Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
  • Trusted by 1,000s of Attorneys and Legal Professionals

Description

AFFIDAVIT OF EXEMPTION FROM THE KENTUCKY WORKERS’ COMPENSATION ACT (INDIVIDUAL). This Kentucky Labor Cabinet form allows an individual to declare exemption from the requirement to obtain workers’ compensation insurance, in accordance with KRS 342.610(5) and KRS 342.340. The affidavit requires the applicant’s name, home address, phone number, FEIN or SSN, and average number of employees. It must be signed by the applicant, notarized, and filed by the local building permit office with the Kentucky Department of Workers’ Claims, Division of Security & Compliance. A copy remains on file with the local permitting office. Fraudulent execution of this affidavit is a criminal offense under KRS 523.030. www.FormsWorkflow.com

Related forms

Our Products