%PDF-1.4
%
1 0 obj
<>>>
endobj
2 0 obj
<>stream
2021-12-03T10:44:15-08:00
2021-12-03T10:44:15-08:00
2021-12-03T10:44:15-08:00
Adobe InDesign 17.0 (Macintosh)
uuid:0ddbf595-b2d9-5a4e-a449-5b6dff1d412a
xmp.did:0b1372a7-4fe1-47f8-a3ee-b6dd89665535
xmp.id:28af9de0-4ef4-432b-985c-907063dc50b7
proof:pdf
converted
from application/x-indesign to application/pdf
Adobe InDesign 17.0 (Macintosh)
/
2021-12-03T10:44:15-08:00
xmp.iid:d7379866-7cfd-4dd6-a976-4f88b4c3b1b0
xmp.did:bf09fa6f-dddb-4168-8766-5001b2135c57
xmp.did:0b1372a7-4fe1-47f8-a3ee-b6dd89665535
default
application/pdf
Adobe PDF Library 16.0.3
False
endstream
endobj
3 0 obj
<>
endobj
5 0 obj
</LastModified/NumberofPages 1/OriginalDocumentID/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 0.0 0.0]>>/PageUIDList<0 236>>/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text]>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
6 0 obj
</LastModified/NumberofPages 1/OriginalDocumentID/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 0.0 0.0]>>/PageUIDList<0 374>>/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text]>>/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>>
endobj
14 0 obj
[16 0 R 17 0 R]
endobj
15 0 obj
<>stream
0 0 0 1 K
0.25 w
/GS0 gs
q 1 0 0 1 17.28 755.875 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 737.405 cm
0 0 m
0 18.345 l
S
Q
q 1 0 0 1 340.905 755.875 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 737.405 cm
0 0 m
0 18.345 l
S
Q
q 1 0 0 1 466.185 755.875 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 737.405 cm
0 0 m
0 18.345 l
S
Q
q 1 0 0 1 593.845 737.405 cm
0 0 m
0 18.345 l
S
Q
q 1 0 0 1 17.28 737.28 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 711.485 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 737.28 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 711.485 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 737.28 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 711.485 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 711.485 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 711.36 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 685.565 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 711.36 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 685.565 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 711.36 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 685.565 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 685.565 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 685.44 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 659.645 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 685.44 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 659.645 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 685.44 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 659.645 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 659.645 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 659.52 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 633.725 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 659.52 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 633.725 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 659.52 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 633.725 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 633.725 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 633.6 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 607.805 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 633.6 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 607.805 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 633.6 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 607.805 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 607.805 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 607.68 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 581.885 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 607.68 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 581.885 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 607.68 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 581.885 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 581.885 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 581.76 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 555.965 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 581.76 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 555.965 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 581.76 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 555.965 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 555.965 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 555.84 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 530.045 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 555.84 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 530.045 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 555.84 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 530.045 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 530.045 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 529.92 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 504.125 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 529.92 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 504.125 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 529.92 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 504.125 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 504.125 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 504 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 478.205 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 504 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 478.205 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 504 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 478.205 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 478.205 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 478.08 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 452.285 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 478.08 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 452.285 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 478.08 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 452.285 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 452.285 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 452.16 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 426.365 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 452.16 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 426.365 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 452.16 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 426.365 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 426.365 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 426.24 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 400.445 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 426.24 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 400.445 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 426.24 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 400.445 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 400.445 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 400.32 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 374.525 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 400.32 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 374.525 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 400.32 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 374.525 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 374.525 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 374.4 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 348.605 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 374.4 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 348.605 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 374.4 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 348.605 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 348.605 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 348.48 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 322.685 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 348.48 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 322.685 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 348.48 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 322.685 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 322.685 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 322.56 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 296.765 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 322.56 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 296.765 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 322.56 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 296.765 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 296.765 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 296.64 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 270.845 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 296.64 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 270.845 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 296.64 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 270.845 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 270.845 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 270.72 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 244.925 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 270.72 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 244.925 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 270.72 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 244.925 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 244.925 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 244.8 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 219.005 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 244.8 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 219.005 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 244.8 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 219.005 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 219.005 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 218.88 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 193.085 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 218.88 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 193.085 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 218.88 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 193.085 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 193.085 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 192.96 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 167.165 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 192.96 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 167.165 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 192.96 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 167.165 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 167.165 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 167.04 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 141.245 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 167.04 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 141.245 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 167.04 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 141.245 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 141.245 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 141.12 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 17.405 115.325 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 340.905 141.12 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 340.905 115.325 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 466.185 141.12 cm
0 0 m
127.785 0 l
S
Q
q 1 0 0 1 466.185 115.325 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 593.845 115.325 cm
0 0 m
0 25.67 l
S
Q
q 1 0 0 1 17.28 115.2 cm
0 0 m
323.625 0 l
S
Q
q 1 0 0 1 340.905 115.2 cm
0 0 m
125.28 0 l
S
Q
q 1 0 0 1 466.185 115.2 cm
0 0 m
127.785 0 l
S
Q
BT
0 0 0 1 k
/GS1 gs
/C0_0 1 Tf
9 0 0 9 156.655 743.585 Tm
<0D9A02D5065905CC122F>Tj
26.432 0 Td
<02DA0C82>Tj
14.052 0 Td
<06961558>Tj
/TT0 1 Tf
10 0 0 10 227.8151 94.2964 Tm
[(NYS W)18.2 (orkers)]TJ
/C0_0 1 Tf
<0008>Tj
/TT0 1 Tf
( Compensation Board )Tj
3.708 -1.2 Td
(Centralized Mailing )Tj
1.278 -1.2 Td
(PO Box 5205 )Tj
-3.466 -1.2 Td
[(Binghamton, NY)17.3 ( 13902)]TJ
/C0_0 1 Tf
10.322 0 Td
<000E>Tj
/TT0 1 Tf
(5205)Tj
/C0_0 1 Tf
9 0 0 9 390.4637 34.7375 Tm
<0F65027F0D8903810C640374065903AE0467006A>Tj
/TT0 1 Tf
[(wcbclaimsfiling@wcb.ny)72.3 (.gov )]TJ
15.294 -1.2 Td
[(www)54.7 (.wcb.ny)74 (.gov)]TJ
-56.598 -0.08 Td
(C)Tj
/C0_0 1 Tf
<000E>Tj
/TT0 1 Tf
[(257 \(1)73.8 (1)]TJ
/C0_0 1 Tf
<000E>Tj
/TT0 1 Tf
(21\) )Tj
/C0_0 1 Tf
<07E00826>Tj
/TT0 1 Tf
( )Tj
ET
endstream
endobj
10 0 obj
<>
endobj
12 0 obj
<>
endobj
20 0 obj
<>
endobj
21 0 obj
<>stream
H\N0y
&.HQ҂? iHԉзǓA 9;;f h7[?}O96ټ0m?Oӽ9C4&LOceu.j{myчbaZOBO\ɧMֻrjxfn|g,]S=k[wv泎YU,%%߂wy~ ?$.Y[\Kr vdV٫D/KMMKMMKMMKMMkL}}KM;iޓk,Y#9}уǾ}:u1CǾ}:@G#!} HK^((/~
***}*|*}*|*}*|*)))))))钼g0߹o14.ߓ8IUe 1
endstream
endobj
22 0 obj
<>stream
H Tgagg'U.!x=$1AADT<l%/ [5"*^3hq1q}fL}{UWӧNW {'
3ش ?.m{ iR~ ɳ.?177Lgm3tL&j_O-ַRbg׳g yrlJ|p IKn<~h M9p\ NZ{r`V> ۛ"v;;(9Ni`^+v'U*GNjkn^>~]w$YoTo=x;={.w#ދۯ?/C>GÆ5z̧ccba\ &%LNM2uZ3g͞so_f.Xs-^ueW[zZXa[n+*c'k8x𑒣Jˎ(?y48[y._Z
5u߸ w-/UEyhWɪ\ 7KslnW]^P~)
/#o'P4mvJk}Q@i4B)>J
N2IϥRY6F"}p9B G˩|y|X/=zި@?\ԯT2t6x
]
-`C!>@W@Q).)ݔ@%X Ud%CTEr@٥PJJrIVÍ~c18ɘ#VVojujjUUrV:4,`IfÏf>KbvɳLg7e+~vC%y