ACORD 174FL Instructions

ACORD 174 FL (2004/04)Florida Revocation of election of Coverage

Use this form to notify the Florida Division of Workers’ Compensation, Bureau of Compliance, that an individual who previously submitted a notice of election of Workers’ Compensation coverage now intends to revoke the election.

ACORD 174 FL is the same as the Florida Division of Workers‘ Compensation form DWC 251-R, revised February 2000.