AGREEMENT TO COMPENSATION BETWEEN THE DEPENDENTS OF DECEASED EMPLOYEE AND EMPLOYER Forms
| Form Name | AGREEMENT TO COMPENSATION BETWEEN THE DEPENDENTS OF DECEASED EMPLOYEE AND EMPLOYER |
| Form # | State Form 18875 |
| Form Revision | (R2 / 5-10) |
| Category | Forms » Death |
| Downloads | |
| Form State | Indiana |
| Language | English |
| State Description | n/a |
| Claimwire Description | The URL provided directs you to Indiana's Workers' Compensation Board, from which you will be able to access the specific form. |