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Description of DB-125
If you become sick or disabled AFTER the first four 4 weeks of unemployment file your claim with the Workers Compensation Board on Form DB-300. For additional information on Disability Benefits call or write the WORKERS COMPENSATION BOARD Office at 100 Broadway Menands ALBANY NY 12241-0005 800 353-3092 DB-125 2-05 Reverse www. DISABILITY BENEFITS HAVE BEEN PROVIDED BY Name Address EMPLOYER U. I. NUMBER BY INSURING...
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db 125 form
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