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Maine Form Center

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		(wcb1) Employer's First Report of Injury - 1/02
		Instructions for Employer's First Report of Injury - 1/02
		(wcb1a) Notice of Workers' Compensation Insurance - 8/96
		(wcb2) Wage Statement - 8/94
		(wcb2a) Schedule of Dependent(s) and Filing Status Statement - 8/94
		(wcb2c) Application for Waiver - 4/08
		(wcb3) Memorandum of Payment - 10/98
		(wcb4) Discontinuance or Modification of Compensation - 8/94
		(wcb4a) Consent Between Employer and Employee - 3/97
		(wcb6) Certificate Authorizing Release of Benefit Information - 3/97
		(wcb8) Certificate of Discontinuance or Reduction of Compensation - 8/94
		(wcb9) Notice of Controversy - 5/06
		(wcb10) Lump Sum Settlement - 3/98
		(wcb11) Statement of Compensation Paid - 3/98
		(wcb12) Employer's Supplemental Report - 8/94
		(wcb25) Motion for Award of Fees and Disbursements - 5/93
		(wcb80) Agreement Between Employer and Employee as to Permanent Impairment - N/D
		(wcb90) Notice to Workers - 1/06
		(wcb120) Petition for Review of Incapacity - 6/98
		(wcb121) Employee Petition for Review of Incapacity/Request for Provisional Order - 6/98
		(wcb122) Petition to Determine Average Weekly Wage - 6/98
		(wcb140) Petition for Award of Compensation - 6/98
		(wcb150) Petition for Award of Compensation - 6/98
		(wcb160) Petition for Award of Compensation - Occupational Disease Law Eff 6/98
		(wcb170) Petition For Restoration - 6/98
		(wcb171) Petition for Award of Compensation - Occupational Disease Law - 6/98
		(wcb180) Petition to Determine Extent of Permanent Impairment - 6/98
		(wcb190) Petition for Payment of Medical and Related Services - 6/98
		(wcb190a) Provider's Petition for Payment of Medical and Related Services - 6/98
		(wcb195) Petition to Remedy Discrimination - 6/98
		(wcb220) Limited Certificate Authorizing Written Release of Medical/Health Care Information - 4/96
		(wcb221) Certificate Authorizing Release of Information - 4/96
		(wcb230) Employee's Return to Work Report - 5/95
		(wcb231) Employee's Return to Work Report - 8/94
		(wcb250) Request for Expedited Proceeding - 8/94
		(wcb260) Application for Predetermination of Independent Contractor Status to Establish Conclusive Presumption - Landowner/Woodharvester - 9/96
		(wcb261) Application for Predetermination of Independent Contractor Status to Establish Rebuttable Presumption - 3/97
		(wcb262) Application for a Certificate of Independent Status - 9/99
		(wcb-vr) Application for Voc Rehab - N/D
		(m1) Practitioner's Report - 6/99
		(m2) Request for Independent Medical Examination - 6/99
		(ComplaintForAudit) Complaint For Audit - 1/03

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