Pittsburgh Pennsylvania Statement of Account of Compensation Paid - For All Workers' Compensation and Occupational Disease cases including fatalities for Workers' Compensation

State:
Pennsylvania
City:
Pittsburgh
Control #:
PA-LIBC392-WC
Format:
PDF
Instant download
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Public form

Description

This is one of the official workers' compensation forms for the state of Pennsylvania.

How to fill out Pittsburgh Pennsylvania Statement Of Account Of Compensation Paid - For All Workers' Compensation And Occupational Disease Cases Including Fatalities For Workers' Compensation?

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Pittsburgh Pennsylvania Statement of Account of Compensation Paid - For All Workers' Compensation and Occupational Disease cases including fatalities for Workers' Compensation