HomeMy WebLinkAboutdwerwath contractor exemption MONTANA DEPARTMENT OF LABOR 83 INDUSTRY
I llffl �, r
INDEPENDE %- g
afeobTk8 �,C R PROGRAM
Department of LabfloLra(& Industry
INDEPENDENT CONTRACTOR
EXEMPTION CERTIFICATE
THIS CERTIFICATE CERTI IES THAT
DANIEL H WERWATH
1726 AGUA FRIA ST
SANTA FE,NM 87505
has sworn to the Department of Labor and Industry that this person is:
• engaged in an independently established trade,occupation,profession,or business;and
• is free from control or direction by hiring agents over the performance of the person's services,both under contract and in fact,
when acting as an independent contractor.
The certificate holder has provided the Department of Labor and Industry sufficient documentation to conclude the certificate holder
has an established business. In reliance on that evidence, the Department of Labor and Industry has granted this Independent
Contractor Exemption Certificate to the person named above.
The certificate holder has waived all rights and benefits under the Workers'Compensation Act of Montana and is not required to be
personally covered by workers'compensation insurance.The certificate holder has acknowledged the certificate holder is responsible
for all taxes related to work performed under the Certificate.
Any certificate holder, hiring agent, employer, or any other person who violates the independent contractor provisions of Title 39,
Chapter 71,MCA may be subject to a S1,000 fine and other penalties provided by law. ,
her• ,!>M,•yb t}'n{ !#, Yu" tLL 1z
rpo This Certificate is effective for the following 1 occupation(s)(list may continue on next page)
HOUSING CONSULTING 4
Effective: 11/03/2014 through 11/02/2016 z „j yi1rr
Ys '
+-E1VD OF OCCUPATION LIST :•:�^-=�=�•<.^;; •-t�
y -
q
,."!•'y a:C; 'k, .a v..!a,sr•:'U.1.'!.; ...
'• t
10
Y+.
G
{ i>
f
- Ya•!. .. 5. x,a•*.. .. ... ...:-.,:.:..: .: ..,: ., a., ;'�:....v,.':,x.-,....,, '> _ IK:� �fi 6Y' l'F:
., +i:.:3,,,...d5.72 ..j.. ...::..:.,-„.::Yr•.r.r. ..::L,' :".:)ti.::y:::a'c`"�',;r- 40
; . .,ice. „ r41..1hT..::,:i;..<:'•: ":>.-a ...-. .": vrf>� .. .., _ + :•C....
u :......
a:'/. V 'I£ \i'- :,:.....:'.'u^^#.h.=if..,::..,.s.: •.::<»e,:,^. ., i ... a.... .,:�55.,:wa;^L`.;i•;:�,'�"
at"g.
-T
• a:
.:v
4 Y :'I
`• .r•
This certificate only applies to the above named person for the listed occupation(s)and does not include any employees the person may hire or any other
subcontractors hired by the above named person.Montana law provides that this Certificate creates a conclusive presumption of this person's status as an
independent contractor.
ATTENTION HIRING AGENTS:
It is advisable to verify that this is valid and effective.Please call(406)444-7734 or visit our website at:www.mtcontractor.com
Please notify the Department of Labor and Industry of any changes to this Certificate.
(406)444-7734-(406)444-3465 fax-(406)444-5549(TTD)-PO Box 8011,Helena,MT 59604-8011
ICEC Reference No.: 125711IC(This is not a registration or license number.)
1 / 1