Fill and Sign the Colorado Notice Intent 497300790 Form

                                                                                                         Registration Number:            Name:       Law Firm:       Address:             City:       State:       Zip             Registration Number:       Name:       Law Firm:       Address:             City:       State:       Registration Number:       Name:       Law Firm:       Address:             City:       State:      ( ) ( ) ( ) - - ( ) ( ) ( ) - - ( ) ( ) ( ) COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT Division of Workers' Compensation 1515 Arapahoe Street, Claims Section Denver, CO 80202-2117 NOTICE OF INTENT TO PRACTICE - (Office Code) - Phone #- Toll Free #- Fax #- (Office Code) Zi p Phone #- Toll Free #- Fax #- (Office Code) Zip Phone #- Toll Free #- Fax #- WC8 Rev.00 Instructions for Notice of Intent to Practice Use this form initially for notifying the Division of Workers' Compensation that you are or will be representing parties before the Division. This form should then be used to report name, firm and/or address changes. It will not be necessary to file these changes on every case if you report the change on this form. Complete your attorney registration number. If you have only one office location, it is not necessary to complete the office code. If you have more than one location, assign an office code of 01 to the first address, 02 to the second, etc. Complete your name, law firm name, address, city, state, zip, phone, fax number and toll free number, if any, for each location. Mail completed form to the Division of Workers' Compensation, 1515 Arapahoe St., Claims Section, Denver, CO 80202-2117. WC8 Rev.00