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File this form with the Department of Labor and Industry at the address or fax number listed at the end of this form. Rehabilitation Response PRINT IN INK or TYPE ENTER DATES in MM/DD/YYY FORMATTERS
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To fill out a form for an address, follow these steps:
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What is at form address or?
The form address or is used for specifying the physical location of a form.
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The form address or should include the street address, city, state, and zip code where the form is to be delivered.
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