Use a Fwisd Affidavit Of Residency template to make your document workflow more streamlined.
Show details Hide detailsName _________________________ Address _________________________ CERTIFIED MAIL Under the provisions of Ark. Code Ann. 11-9-527, workers’ compensation benefits are being paid to you as a dependent of . You will continue to receive these benefits until your death. We ask you to complete, sign, have notarized, and return this Affidavit to our office at the address above within thirty (30) calendar days. Failure to do so will result in suspension of your benefit checks. If you have questions.
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