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Get NY C-2.0 2008

His form within 10 days of the injury/illness or be subject to a penalty. For additional information on filing this form please refer to Workers' Compensation Law Section 110 at the end of this form. Type or print neatly. WCB Case Number (if you know it): Date of Injury/illness: _____/_____/_____ Date of this Report: _____/_____/_____ A. EMPLOYER INFORMATION 1. Employer: 2. Employer FEIN: 3. Mailing Address: 4. Location Address (if different): 5. Phone Number: (______)______________________.

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