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Get Michigan Form 112

MI 48913 REQUEST NUMBER FUNDS ADMINISTRATION 1. 2. 3. 4. 5. 6. Total & Permanent Disability Provision - Section 521 (1) (2) 70% Reimbursement Provision - Section 862 Two Years of Continuous Disability Provision - Section 356 (1) Vocationally Handicapped Provision - Section 925 Dual Employment Provision - Section 372 Silicosis, Dust Disease and Logging Industry Compensation Fund - Section 531 CARRIER FILE NUMBER COMPLETE THIS SECTION FOR ALL FUNDS Applications for reimbursement should be subm.

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