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Get MI WC-105B 2019-2023

Closed in this questionnaire may be used by the magistrate to facilitate exchange of information as required by Stokes v Chrysler, LLC, 481 Mich 266 (2008). Completion is voluntary. Completed forms should be exchanged among all parties and not sent to the Workers’ Disability Compensation Agency. Use of this questionnaire does not limit the parties’ rights to request further disclosure as provided in that decision. Employee Name Social Security Number (last four digits only) XXX-XX- Date o.

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