Application To Self-Insure Workers' Compensation Liabilities - South Dakota Department Of Labor And Regulation Page 4

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3. FINANCIAL DATA
Please provide audited annual financial statements for the three (3) most recent years.
If audited annual financial statements are not available, please provide a balance sheet, income statement and statement of change
in financial position for each year.
If the most recent audited annual financial statement does not report your financial position at a date within six (6) months of the
beginning of the self-insurance year (September 1, 2016), provide an interim financial statement.
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