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Document Number: WKC-176
Description: This form is to be filed when there is approval of compensation resolving a dispute.
Comments: This form is not fill enabled. It can be printed and completed by hand.
Content Contact: Don Martin
Document Attachment: WKC-176 (pdf/11 KB)
***Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page. Links to each specific vendor's site have been provided for you. Thank you.