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Get Ga Wc-25 2007-2024

N with the Board within 15 days of the date on the certificate of service (O.C.G.A. !9-11-6(e)). If no response is received within the 15 day period, the Board will assume that the request is unopposed. Mail to the State Board of Workers' Compensation, 270 Peachtree Street, N.W., Atlanta, Georgia 30303-1299 Board Claim No. Employee Last Name Employee First Name M.I. Social Security Number Date of Injury A. IDENTIFYING INFORMATION County of Injury Address EMPLOYEE City State Zip Code.

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