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17111 Hawthorne Blvd. 4081028032 H₂×2 of 3WORKERS COMPENSATION DECLARATIONAPPLICATION FOR BUILDING pftlMITaffirm that I hove a certificate of consent to self insure, or o certificate of Workers
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It is a form for reporting income and expenses related to the property located at 14926 Hawthorne in the city.
The property owner or the designated financial representative is required to file.
Fill out the form with accurate income and expense information related to the property at 14926 Hawthorne in the city.
The purpose is to report income and expenses to the city for tax or regulatory purposes.
Income and expenses related to the property at 14926 Hawthorne in the city.
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