Form C 159 PDF Details

In order to file your taxes, you will need to complete Form C 159. This form is used to calculate your net income and determine the amount of tax you owe. The instructions for completing the form are outlined on the second page, and you can find a sample return on the third page. You will need to enter all of your income and deductions in the appropriate boxes, and then subtract the total of your deductions from your income. The resulting number is your net income, which is what you will use to calculate your tax liability. Make sure to include all of your sources of income on this form, even if they are not taxable. You may also be able to claim certain deductions, such as those for medical expenses or charitable donations. Be sure to familiarize yourself with the allowable deductions before filing your return.

QuestionAnswer
Form NameForm C 159
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesBWC, C-159, relinquishes, Pursuant

Form Preview Example

Waiver of Workers’ Compensation Benefits for Recreational or Fitness Activities

Instructions

Complete this form to waive workers’ compensation coverage for voluntary participation in employer-sponsored recreational activities or itness programs.

In the space provided, list all employer-sponsored recreational activities and itness programs for which the employee wishes to waive work- ers’ compensation coverage. Make a line through any blank spaces.

The employee must sign and date this form to acknowledge agreement.

The employer shall retain the original for his or her iles and provide a copy to the employee.

The employer should submit a copy to BWC only when an employee files a claim for an injury or occupational disease sustained in the em- ployer- sponsored recreational activity or itness program. For further information call 1-800-644-6292.

Employee name (please print or type)

Date

Employer name

Risk number

Pursuant to Section 4123.01(C)(3) of the Ohio Revised Code (ORC), the employer and employee shall list those employer-sponsored recreational activities and itness programs for which the employee wishes to waive all rights to compensation and beneits under Chapter 4123 of the ORC. The waiver must be signed and dated prior to the date of injury or, in an occupational disease claim, the date of disability. Should an employee sustain an injury or occupational disease in an employer-sponsored recreational activity or itness program which is not listed, the employee may be eligible for workers’ compensation beneits.

Recreational activities/Fitness programs

The undersigned declares that he or she is a voluntary participant in the employer-sponsored recreational activities or itness programs listed above. He or she hereby waives and relinquishes all rights to workers’ compensation beneits under Chapter 4123 of the ORC for any injury or disability incurred while participating in the above activities or programs. This waiver is valid for two calendar years. The waiver may not bar any workers’ compensation claim iled for death beneits by the employee’s dependents.

Employee signature

Date signed

BWC-1286 (12/29/1997)

C-159 (previously OIC-0161)