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Pa Statement Of Wages Form For Injuries Occurring Are The Periods Based On Dates Worked Or Dates Paid

State:
Pennsylvania
Control #:
PA-LIBC494C-WC
Format:
PDF
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Description

This is one of the official workers' compensation forms for the state of Pennsylvania.

How to fill out Pennsylvania Statement Of Wages - For Injuries Occurring On And After June 24, 1996 For Workers' Compensation?

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Pa Statement Of Wages Form For Injuries Occurring Are The Periods Based On Dates Worked Or Dates Paid