Employees Statement Of Exempt Status {DB-130}

DB-130 - EMPLOYEE'S STATEMENT OF EXEMPT STATUS. Annually, eligible employees must reaffirm the Employee's Statement of Exempt Status. Upon receipt of a completed Exempt Status form, the application shall be deemed filed and the employee shall be exempt from withholding for the upcoming rate year. Additionally, in order to maintain an exempt status if you change employment, an Employee's Statement of Exempt Status (DB-130), must be executed and filed with each new employer and with the Chair of the Workers' Compensation Board. Two copies of this form must be completed and signed. Mail one copy to the Workers' Compensation Board and file one signed copy with your employer. www.FormsWorkflow.com