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• <br /> PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE <br /> IMPORTANT <br /> FLORIDA <br /> = WORKERS' COMPENSATION NT OF FINANCIAL SERVICES <br /> )F F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation w o <br /> UCTION INDUSTRY � •' , CI elects exemption from this chapter by filing a certificate of e e <br /> lction <br /> 4TE OF ELECTION TO BE EXEMPT FROM FLORIDA ° ,b n 0 L under this section may not recover benefits or compensation under this <br /> r COMPENSATION LAW D chapter. <br /> /E: 02/05/2008 EXPIRATION DATE: 02/ 04 / 2010 Pursuant to Chapter 440.05(12), F.S., Certificates of election or trade to be listed on <br /> VICTOR OWENS JR H exempt... apply only within the sco of the business <br /> E the notice of election to be exempt. <br /> 593377983 R i <br /> S NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), F.S., Notices shall be of election t ect to o be exempt revocation - <br /> R CONDITIONING & HEATING INC and certificates of election to be exempt <br /> KEY TREE LN if, at any time after the filing of the no <br /> Y, FL 33567 certificate, the person named on the notice tice or or certificate the no Issuance longer of the meets <br /> the requirements of this section for issuance of a certificate. The <br /> department shall revoke a certificate at any time for failure of the ! <br /> OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this <br /> section. <br /> JG & AIR CONDITIONING QUESTIONS? (850) 413 -1609 <br /> CUT HERE <br /> * Carry bottom portion on the job, keep upper portion for your records. <br /> CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 <br /> 9643 __ 7.1 ' TOTE -OF F LORIDA <br /> DEPARTMENT OF 1 3 4 - - - - ESS AND PROFESSIONAL REGULATION <br /> CONS=TRUCTT€ N IisIDU - -TRY LICENSING BOARD SEQ# L0 0079 <br /> IATE BATG�# NUMBEi2 =LI CEN SE = <br /> ' <br /> 1/`2,008. '088051121: CACO'543- 3 * -e , <br /> CLASS B AIR CONDITIONINE- CONT" CT <br /> 3 below IS CERTIFIED , <br /> r the provisions of Chapter -„,,,,, . <br /> ration date: AUG' 31, 201:0 <br /> DWENS, VICTOR JR ' <br /> DWEN' S AIR CONDITION 1 � rte: i IEI I NC 583 'TURKEY TREE; ,r u� .' <br /> PLANT CITY FL 33 -5'67 <br /> CHARLIE CRIST _ CHARLES -W DRAGO <br /> GOVERNOR SECRETARY <br /> . D PLA -AS R€QUIRED1 BY LAW <br />