Notice Of Revocation Of Election To Be Exempt Page 2
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1
2SUBMIT THIS FORM TO THE DISTRICT OFFICE LISTED BELOW
THAT IS CLOSEST TO YOUR PLACE OF BUSINESS:
WORKERS’ COMPENSATION COMPLIANCE FIELD OFFICES
2295 Victoria Ave. Suite 163
921 N. Davis St.
401 NW 2nd Ave.
Ft. Myers, FL 33901
Building B, Suite #250
Suite #321 South Tower
Telephone (239) 461-4006
Jacksonville, FL 32209
Miami FL 33128
Telephone (904) 798-5806
Telephone (305) 536-0306
610 E. Burgess Road
Pensacola, FL 32504-6320
400 West Robinson St.
Telephone (850) 453-7804
Room #512 North Tower
TALLAHSSEE SUBMITTERS
Orlando FL 32801
Walk-in submissions:
3111 South Dixie Hwy.
Telephone (407) 245-0896
2012 Capital Circle SE
Suite #123
Suite #102 Hartman Bldg.
th
West Palm Beach FL 33405
499 Northwest 70
Avenue
Tallahassee FL 32399-2161
Telephone (561) 837-5716
Suite #116
Telephone (850) 413-1609
Plantation FL 33317
1313 N. Tampa St. Suite #503
Telephone (954) 321-2906
Mail in submissions:
Tampa FL 33602
200 East Gaines Street
Telephone (813) 221-6506
Live Oak Business Center
Tallahassee FL 32399-4228
5969 Cattlemen Lane
Telephone (850) 413-1609
th
1111 NE 25
Ave. Suite #403
Sarasota FL 34232
Ocala FL 34470
Telephone (941) 329-1120
Telephone (352) 401-5350
WORKERS’ COMPENSATION INFORMATION ONLINE -
DWC 250-R, NOTICE OF REVOCATION OF ELECTION TO BE EXEMPT - REVISED 12/08; RULE 69L-6.009, F.A.C.
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