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Get AR AR-N 2001

Ail: P. O. Box 950, Little Rock, AR 72203-0950 501-682-3930 / 1-800-622-4472 Ark. Code Ann. §§11-9-701, 508, 514 AWCC Rule 33 Revised: 1-1-2001 EMPLOYEE’S NOTICE OF INJURY EMP LOYE E INFOR MAT ION (Please Print in Ink) Employee’s Last Name First Name M I Street Address or P.O. Box Social Security Number City Home Phone No. State Zip Code EMP LOYE R INFO RMA TION (Please Print) ARKANSAS FORESTRY COMMISSION Employer’s Name Supervisor’s Name 3821 W. Roosevelt Road Little R.

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