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Fill and Sign the Workers Compensation Board Hearing Site Locationsopen Form

Fill and Sign the Workers Compensation Board Hearing Site Locationsopen Form

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Open the document and fill out all its fields.
Apply your legally-binding eSignature.
Save and invite other recipients to sign it.

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STATE OF NEW YORK WORKERS' COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVESPEOPLE WITH DISABILITIES WITHOUTDISCRIMINATION. APPLICATION FOR A FEE BY CLAIMANT'S ATTORNEY OR REPRESENTATIVE in accordance with Board Rule 12 NYCRR 300.17 Unless specifically requested by the Board, this form is required only where the amount of the fee requested is more than $450.00. * TO THE CLAIMANT: IF YOU DID NOT OR WILL NOT ATTEND THE HEARING AT WHICH THIS FEE REQUEST IS SUBMITTED TO THE BOARD, SEE SECTION C, ITEM 6 ON REVERSE. Claimant's Name Claimant's Social Security Number WCB Case No. Representative's Identification Number, If Any Date Retained Amount of Fee Previously Received, If Any

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The best way to complete and sign your workers compensation board hearing site locationsopen form

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  • 2.Launch the application, tap Create to add a template, and choose Myself.
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How to Sign a PDF on Android How to Sign a PDF on Android

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  • 4.Tap on Tools tab -> Signature, then draw or type your name to eSign the form. Fill out blank fields with other tools on the bottom if required.
  • 5.Use the ✔ key, then tap on the Save option to finish editing.

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