Electronic Attachment | Pdf Fpdf Doc Docx | New York

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Electronic Attachment | Pdf Fpdf Doc Docx | New York

Electronic Attachment

This is a New York form that can be used for Workers Compensation.

Alternate TextLast updated: 11/8/2010

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State of New York Workers' Compensation Board Attachment to Form Claimant's Last Name Dated Claimant's First Name WCB Case Number Carrier Case Number Claimant's Soc. Sec. No. Date of Accident or Injury Electronic Attachment (05/01) 2002 © American LegalNet, Inc.

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