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THIS SPACE FOR COMMISSION USE ONLYCCFORM36AWORKERS COMPENSATION COMMISSION 1915 NORTH STILES AVENUE STE 231 OKLAHOMA CITY, OK 73105File original and two (2) copies with the Workers Compensation Commission
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1915 oklahoma wcc insurer 36a jobsite ste compensable thecontractor false affiant customarily nonrefundable falsify representations irs gov engages herein coercion pursuant monies incurred exempt knowingly presumption payable executing punishable specific

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