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Get Ny C-8.1.0 2014-2024

SHOULD REFER TO THESE NUMBERS 1. W.C.B Case Number 2. Carrier Case Number 3. Carrier Code Name 4. Date of Injury 5. Social Security Number Address to which notices should be sent 6. Claimant Apt. No. 7. Employer 8. Carrier 9. Claimant's Medical Provider *In volunteer firefighters' and volunteer ambulance workers' benefit cases, the liable political subdivision (or unaffiliated ambulance service as defined in Sec. 30 VAWBL) is deemed to be the "EMPLOYER." PART B PART A NOTICE OF OB.

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