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  • Tn Form C-41 Lb-0384 2015

Get Tn Form C-41 Lb-0384 2015-2025

Tennessee Bureau of Workers Compensation 220 French Landing Drive, IB Nashville, TN 372431002 FORM C41WAGE STATEMENT EMPLOYEE: SSN:STATE FILE #:Employer Ins Claim # Date of Injury:.

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How to fill out the TN Form C-41 LB-0384 online

Filling out the TN Form C-41 LB-0384 online can be a straightforward process when you have the right guidance. This guide will walk you through each section of the form to ensure accurate completion.

Follow the steps to successfully complete your wage statement

  1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
  2. Begin by entering the employee's name in the designated field labeled 'EMPLOYEE.' Ensure you include the full name as shown on their identification documents.
  3. Next, input the Social Security Number (SSN) of the employee in the 'SSN' field. This number is crucial for identification purposes.
  4. Fill in the 'STATE FILE #' and 'Ins Claim #' sections with the relevant claim numbers assigned to the state and insurance.
  5. In the 'Employer' field, write the name of the employer as registered with the relevant authorities.
  6. Specify the 'Date of Injury' by selecting the appropriate date from the calendar options or entering it manually in the format MM/DD/YYYY.
  7. For each of the 52 weeks prior to the date of injury, fill out the 'GROSS WAGES' and 'WEEK ENDING' columns. Be meticulous to ensure that the data recorded accurately reflects the wages earned.
  8. At the end of the wage entries, calculate and record the 'TOTAL PAID' at the bottom of the form.
  9. Complete the form by entering the date of preparation and the name and title of the preparer in the final section.
  10. Once you have filled out all required fields, you can save any changes you've made, download the form, print a copy, or share it as needed.

Start filling out your TN Form C-41 LB-0384 online today!

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232