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Get Notice Of File Closing - Minnesota Department Of Labor And Industry

TO NOTIFY YOUR OFFICE THAT ALL PAYMENTS AND OTHER ACTIVITIES HAVE BEEN COMPLETED ON THIS FILE. AS A RESULT, WE ARE NOW CLOSING IT ON OUR SYSTEM. CLAIM REPRESENTATIVE NAME DATE ADDRESS INSURER/SELF-INSURER/TPA CITY Send completed form to: STATE ZIP CODE PHONE NUMBER (include area code) Minnesota Department of Labor and Industry Workers Compensation Division PO Box 64221 St. Paul, MN 55164-0221 This material can be made available in different forms, such as large print, Braille or o.

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