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Get Si 42 Fillable
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How to use or fill out the Si 42 Fillable online
The Si 42 Fillable form is crucial for those involved in self-insured settlements within the state of Ohio. This guide provides step-by-step instructions to assist users in accurately completing the form online, ensuring all necessary information is submitted correctly.
Follow the steps to fill out the Si 42 Fillable online effectively.
- Press the ‘Get Form’ button to access the Si 42 Fillable document and open it in your preferred online editing platform.
- Begin by filling in the name of the injured worker and their Social Security number in the designated fields.
- Next, enter the employer's name and the claim number associated with the injury.
- Indicate the date of injury or occupational disease by selecting the correct date from the available calendar or typing it in.
- In the settlement agreement section, input the monetary amount agreed upon for the settlement.
- In the release section, ensure to clearly state the names of both the injured worker and the employer.
- Review the terms related to medical costs, stating who is responsible for what, and fill in any additional claims to be excluded from this settlement.
- Finalize the form by signing and dating where indicated for both the injured worker and the employer.
- Include the current address, city, state, and ZIP code for both parties, as specified in the form.
- If applicable, have the notary public complete their section, certifying the appearance of the injured worker.
- Lastly, if there is an attorney of record, they should sign and certify that the injured worker understood the agreement.
- Once all sections are filled out correctly, you can save changes, download, print, or share the completed form as needed.
Complete your documents online seamlessly for a smoother filing process.
Making a fillable file requires selecting a PDF form editor equipped with filling capabilities. Once you have your document, add fields where users can input their information. The Si 42 Fillable template on US Legal Forms provides an excellent starting point, allowing you to create a user-friendly fillable file quickly and efficiently.
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