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DEPARTMENT OF LABOR AND INDUSTRIES CLAIMS SECTION PO BOX ... 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the date at the top of the form. This is essential for processing your claim.
- Fill in your Claim Number and Folio Number, which can be found on previous correspondence from the Department.
- In the Declaration of Entitlement section, print your name clearly as the recipient and provide your mailing address, including city, state, and zip code.
- Indicate whether your residence address is the same as your mailing address by selecting 'Yes' or 'No'. If 'No', list your residence address.
- Sign in the designated signature block. If you are signing on behalf of someone else, ensure to include a copy of the power of attorney.
- Complete any additional sections regarding dependents and changes in status as required. Be thorough to avoid delays.
- Finally, ensure that a notary public signs and stamps the document before submission for validation.
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