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ACORD Form 174 KS Kansas Election Not To Accept Coverage Instructions

 

 
Section Name Field Name Field and/or Section Description
Use this form to notify the Kansas Division of Workers Compensation that an employee
TITLE Kansas Election Not to Accept who owns 10% or more of the stock in a corporation elects not to accept workers
ACORD 174 KS (2005/11) Coverage compensation coverage.

ACORD 174 KS (2005/11) 1 of 1