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Get Georgia Form Wc 244

Print Name Here Signature Date IF YOU HAVE QUESTIONS PLEASE CONTACT THE STATE BOARD OF WORKERS COMPENSATION AT 404-656-3818 OR 1-800-533-0682 OR VISIT http //www. sbwc.georgia.gov WILLFULLY MAKING A FALSE STATEMENT FOR THE PURPOSE OF OBTAINING OR DENYING BENEFITS IS A CRIME SUBJECT TO PENALTIES OF UP TO 10 000. C. CERTIFICATION I hereby certify that I have sent a copy of this form to all parties and counsel in this claim and to the State Board of.

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