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PLEASE TYPE OR PRINT LEGIBLY. State Form 12386SELFINSURED EMPLOYER CERTIFICATIONSTATE COUNTY OF, hereby CERTIFY that I am(Official Title)of and that I have knowledge of the(Company)workers compensation
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State form 12386 is a tax form used for reporting income and expenses related to a specific state tax obligation.
Individuals or businesses who have a state tax obligation that requires reporting of income and expenses.
State form 12386 can be filled out by providing accurate information regarding income, expenses, and other relevant details as requested on the form.
The purpose of state form 12386 is to accurately report income and expenses to fulfill state tax obligations.
Information such as income sources, expenses incurred, deductions, and other relevant financial details must be reported on state form 12386.
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