Attorney Mailing & Email Address Change Form
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Attorney Mailing & Email Address Change Form
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* Indicates Required Field
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IMPORTANT: If you are a Designated Service Agent you will need to complete the CC-Form 7 in addition to the change of address form.
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New Contact Information |
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I declare under penalty of perjury that I have examined this application and all statements contained herein, and to the best of my knowledge and belief, they are true, correct and complete. |
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Administrative Workers’ Compensation Act, 85A O.S., §6(A)(1)(a): “Any person or entity who makes any material false statement or representation, who willfully and knowingly omits or conceals any material information, or who employs any device, scheme, or artifice, or who aids and abets any person for the purpose of: (1) obtaining any benefit or payment … shall be guilty of a felony.”
Any person who commits workers’ compensation fraud, upon conviction, shall be guilty of a felony punishable by imprisonment, a fine or both. |
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