Form 142 – Statement of Insurance Carrier or Self Insurer With Respect to Discontinuance of Benefits

Occupational Safety & Health

This government document is issued by Occupational Safety & Health for use in Utah

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File Details: PDF (692 KB)
Source
https://laborcommission.utah.gov/wp-content/uploads/2019/11/Form-142-Revised-2-2019.pdf

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