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Homeowner shall be liable for contractor compliance with this requirement. Contractor has no employees. Dickinson Township 219 Mountain View Road Mount Holly Springs PA 17065 Phone 717 486-7424 Fax 717 486-8412 www. dickinsontownship.org AFFIDAVIT OF EXEMPTION WORKERS COMPENSATION INSURANCE YEAR The undersigned affirms that he/she is not required to furnish Workers Compensation Insurance under the provisions of the Pennsylvania s Workers Compensation law for one of the following reasons...
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