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PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> STATE OF FLORIDA IMPORTANT <br /> DEPARTMENT OF FINANCIAL SERVICES <br /> DNISION OF WORKERS' COMPENSATION n ; : F to Chapter 440.05(14 ), F.S., an officer of a corporation who <br /> CONSTRUCTION INDUSTRY O elects exemption from this chapter by filing a certificate of election <br /> CE TE OF ELECT <br /> T LAw EXEMPT FLORIDA 0 ` 4 L under this section may not recover benefits or compensation under this <br /> D chapter. <br /> EFFECTIVE: 02/13/2009 EXPIRATION DATE: 02/13/2011 <br /> Pursuant to Chapter 440.05(12), F.S., Certificates of election to be <br /> PERSON: SHAWN OLDHAM H exempt.. apply only within the scope of the business or trade listed on <br /> FEIN: 208250145 E the notice of election to be exempt <br /> BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), F.S., Notices of election to be-exempt <br /> SCENIC VIEW DESIGN AND CONSTRUCTION LLC <br /> 932 SCENIC VIEW CIRCLE and certificates of election to be exempt shall be subject 10 revocation <br /> if, at any time after the filing of the notice or the issuance of the <br /> CLERMONT, FL 34715 certificate, the person named on the notice or certificate no longer meets <br /> the requirements of this section for issuance of a certificate. The <br /> department shell revoke a certificate at any time for failure of the <br /> SCOPE OF BUSINESS OR TRADE person named on the certificate to meet the requirements of this <br /> 1- CERTFIED GENERAL CONTRACTOR section. <br /> QUESTIONS? (850) 413 -1609 <br /> CUT HERE <br /> e Carry bottom portion on the job, keep upper portion for your records. <br /> DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 <br />