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Get MI DHS-38 2007

Er’s Compensation claim pending? No Date Filed To: Zip Code Yes Next Court Date SECTION 5 - ADDITIONAL INFORMATION/COMMENTS Employer’s Response (To Be Completed By Employer) Additional Information Requested Employer’s Comments SECTION 6 – SIGNATURE/BUSINESS INFORMATION (To Be Completed By Employer) Business Name Days and Hours of Operation Business Address Name of Person Completing Form (Please Print) Business Telephone Number ( Signature of Person Completing Form Employer Fe.

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