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Get Ny Rb-89.1 2011

De Carrier's Name Claimant's Name Date of Injury Address TO THE SENDER: This Rebuttal of an Application for Board Review may be filed with the Board by fax (1-877-533-0337; see Subject No. 046-144), e- mail (wcbclaimsfiling@wcb.ny.gov); see Subject Nos. 046-144 and 046-375), personal delivery to a Board District Office, or by mailing to one of the Board addresses listed at the top of this page. A copy of this Rebuttal must be served on all parties in interest. Sections 1 and 2 on the revers.

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