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Get the free BEFORE COMPLETING THIS STATEMENT READ INSTRUCTIONS ON REVERSE SIDE - wcb ny

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STATE OF NEW YORK ... IMPORTANT: USE THIS FORM ONLY WHEN YOU BECOME SICK OR DISABLED AFTER FOUR .... DB-300 (2-04) ..... may download it from our web page, www.wcb.ny.gov.
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Before completing this statement, you must ensure all relevant information is gathered.
All individuals or entities who are obligated to provide the information must file before completing this statement.
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The purpose of completing this statement is to report important information to the appropriate authorities.
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