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Get MO DWC WC-G-11 2012-2024

above and that EMPLOYEE DID NOT APPEAR IN PERSON BECAUSE OF HARDSHIP OR OTHER EXTENUATING CIRCUMSTANCES. By initialing the following box, EMPLOYEE indicates full awareness of the consequences of this settlement as set out above and that EMPLOYEE personally appeared. Employee’s Signature (Notary is required only if employee is not represented and does not appear.) Subscribed and sworn to before me this _______________ day of ____________________________. My commission expires: NOTARY PUBLIC:.

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