Laserfiche WebLink
!.afrC� at U� r c Pll `i r I ; 7F <br /> t y s �F [t <br /> ACCOUNT NOt 084941 TYPE OF BUSINESSt <br /> SICCODE: 1799.05 FENCE INSTALLATION <br /> LOCATION ADDRESS: I <br /> PASCO FENCE CO -INC 4254 PLUM ST <br /> 4254 PLUM ST ZEPHYRHILL "S <br /> ZEPHYRHILLS FL 33542 -5939 <br /> DATE RECEIPT AMOUNT I <br /> 09/27/10 597158 33.75 <br /> IIIIl aa a nlaalaiIlal�dll�lIIIiIIlla llrlll 111 �IIuI111 1 I111 <br /> I ' <br /> .. :.:. ...., ,. ., _.::� x�..:. •rsJas� ,.Y S. :_. .. F . ,« .. 4•.`Y X ' >:.'.R_'F'iSM1tilflkY9a.,'!S.":. .. m�,. t u,.'. ..ar .... ....: .. ..gym .:. .. r. ... Z <br /> 09 -16 -2010 <br /> slo <br /> ALEX SINK STATE OF FLORIDA <br /> CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES <br /> DIVISION OF WORKERS' COMPENSATION <br /> * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW * * <br /> CONSTRUCTION INDUSTRY EXEMPTION <br /> This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. <br /> EFFECTIVE DATE: 09/16/2010 EXPIRATION DATE: 09/15/2012 <br /> PERSON: WILTON TOMMY <br /> FEIN: 273132876 <br /> BUSINESS NAME AND ADDRESS: <br /> PASCO FENCE CO INC <br /> 4254 PLUM STREET <br /> ZEPHYRHILLS FL 33542 <br /> SCOPES OF BUSINESS OR TRADE: <br /> 1- FENCE ERECTION <br /> IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this <br /> section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the <br /> scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of <br /> election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate the person named on the notice or <br /> certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person <br /> named on the certificate to meet the requirements of this section. <br /> QUESTIONS? (850) 413 -1609 <br /> DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 <br />