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30 W. Spring St.
Columbus, OH 43215Certificate of Ohio Workers\' Compensations certifies that the employer listed below participates in the Ohio State Insurance Fund as required
by law. Therefore,
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The purpose of this form is to provide official documentation of a claim or statement that needs to be verified.
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The form typically requires information such as the claimant's name, the claim or statement being certified, and the date of certification.
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