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If you have any questions call 462-8100 option 5. DWC-11-IC 3/2006 DWC-11-IC Reverse Side This is a form DWC11-IC Designation of Independent Contractor. When your work as an independent contractor ends with this employer complete and return the form titled Notice of Withdrawal of Designation as Independent Contractor DWC-11-ICR to the Dept.
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dwc 11 ic
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