Forms Catalog Document - LS267 :-: ESA :-: Claimant's Statement

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Claimant's Statement

This form is used to verify the continued entitlement of claimants to received death benefits from the Special Fund.

Form #: LS 267
Agency: Department of Labor
Bureau: Employment Standards Administration
Common Name: LS-267

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Form Only	2		[3] Fillable + Printable	Adobe Reader Download

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