State of Pennsylvania Forms in Word

Form No.	Form Title	Price	Buy Now
PA REV-1500EX+	Inheritance Tax Return Resident Decedent (3 pages)	$18.50
PA REV-1502EX+	Schedule A Real Estate	$18.50
PA REV-1503EX+	Schedule B Stocks and Bonds	$18.50
PA REV-1504EX+	Schedule C Closely-Held Corporation, Partnership or Sole Prioprietorship	$18.50
PA REV-1507EX+	&Schedule D Mortgages & Notes Receivable	$18.50
PA REV-1508EX+	Schedule E Cash, Bank Deposits & Misc. Personal Property	$18.50
PA REV-1509 EX+	Schedule F Jointly-Owned Property	$18.50
PA REV-1510EX+	SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY	$18.50
PA REV-1511 EX+	Schedule H Funeral Expenses and Administrative Costs	$18.50
PA REV-1512 EX+	Schedule I Debts of Decedent, Mortgage Liabilities & Liens	$18.50
PA REV-1649 EX+	Schedule O Election under Sec. 9113(A) (Spousal Distributions)	$18.50
PA REV-1514 EX+	Schedule K Life Estate, Annuity and Term Certain	$18.50
PA REV-1647 EX+	SCHEDULE M FUTURE INTEREST COMPROMISE	$18.50

State of Pennsylvania Workers Compensation Forms in Word

Note, these forms are available from the State of Pennsylvania at this link: http://www.portal.state.pa.us/portal/server.pt/community/forms/10421 in PDF and other formats for free; we are just offering them in Microsoft Word for a fee in case you prefer that use. They do scan some of their workers’ comp forms, so although we try to be as exact as we can, we can’t guarantee they will scan correctly.

Form No.	Form Name	Price	Buy Now
LIBC-9	Medical Report Form	$40.00
&LIBC-10	Authorization for Alternative Delivery of Compensation Payments	$40.00
LIBC-14	Instructions for Religious Exception Application	$40.00
LIBC-14A	Section 304.2 Application for Religious Exception of Specified Employes from the Provisions of the Pennsylvania Workers’ Compensation Act	$40.00
LIBC-14B	Employe’s Affidavit and Waiver of Workers’ Compensation Benefits and Statement of Religious Sect	$40.00
LIBC-134	Dismemberment Chart – Hand	$40.00
LIBC-134F	Dismemberment Chart – Foot	$40.00
LIBC-336	Agreement for Compensation	$40.00
LIBC-337	Supplemental Agreement for Compensation	$40.00
LIBC-338	Agreement for Compensation for Death	$40.00
LIBC-339	Supplemental Agreement for Compensation for Death	$40.00
LIBC-340	Agreement to Stop (Final Receipt)	$40.00
LIBC-362	Claim Petition	$40.00
LIBC-363	Fatal Claim Petition	$40.00
LIBC-364B	Defendant’s Answer to Claim Petition Under PA Occupational Disease Act	$40.00
LIBC-374	Defendant’s Answer to Claim Petition under PA Workers’ Comp. Act	$40.00
LIBC-375	Claim Petition for Additional Compensation From the Subsequent Injury Fund	$40.00
LIBC-376	Petition for Joinder	$40.00
LIBC-377	Answer to Petition To/For:	$40.00
LIBC-378	Petition To/For: &Important Notice	$40.00
LIBC-380	Third Party Settlement Agreement	$40.00
LIBC-384	Fatal…Covered by PA Occupational Disease Act	$40.00
LIBC-386	Fatal…Resulting from Occupational Disease	$40.00
LIBC-392A	Final Statement of Account of Compensation Paid	$40.00
LIBC-396	Occupational Disease Claim Petition (under section 301(1) only)	$40.00
LIBC-480	Subpoena	$40.00
LIBC-494A	Statement of Wages (for injuries occurring on or before June 23, 1996)	$40.00
LIBC-494C	Statement of Wages (for injuries occurring on or after June 24, 1996)	$40.00
LIBC-495	Notice of Compensation Payable (NCP)	$40.00
LIBC-496	Notice of Workers’ Compensation Denial (NCD)	$40.00
LIBC-497	Physician’s Affidavit of Recovery	$40.00
LIBC-498	Commutation of Compensation	$40.00
LIBC-499	Petition for Physical Examination	$40.00
LIBC-500	Insurance Posting Form	$40.00
LIBC-501	Notice of Temporary Compensation	$40.00
LIBC-502	Notice Stopping Temporary Compensation	$40.00
LIBC-507	Application for Fee Review Pursuant to Section 306 (F.1)	$40.00
LIBC-510	Employer’s Application to Elect Domestic Employees to Come Within Provisions of the Workers’ Compensation Act: Section 321	$40.00
LIBC-550	Claim Petition for Benefits from the Uninsured Employer and the Uninsured Employers Guaranty Fund	$40.00
LIBC-551	Notice of Claim Against Uninsured Employer	$40.00
LIBC-601	Utilization Review Request (Instruction Sheet and Form)	$40.00
LIBC-603	Petition to Review Utilization Review Determination	$40.00
LIBC-606	Request for Hearing to Contest Fee Review Determination	$40.00
LIBC-662	Application for Supersedeas Fund Reimbursement	$40.00
LIBC-749	Death Claim Supplement to Compromise and Release Agreement	$40.00
LIBC-750	Employee Report of Wages and Physical Condition	$40.00
LIBC-751	Notice of Suspension or Modification	$40.00
LIBC-753	Notice of Request for Informal Conference	$40.00
LIBC-754	Informal Conference Agreement Form	$40.00
LIBC-755	Compromise and Release Agreement	$40.00
LIBC-756	Employee’s Report of Benefits for Offsets	$40.00
LIBC-757	Notice of Ability to Return to Work	$40.00
LIBC-758	Notice to Employee Note: This form is to be attached to LIBC-378 (“Petition To:” form).	$40.00
LIBC-760	Employee Verification of Employment, Self-Employment	$40.00
LIBC-761	Notice of Workers’ Compensation Benefit Offset	$40.00
LIBC-762	Notice of Suspension-Failure to Return Form LIBC-760	$40.00
LIBC-763	Notice of Reinstatement of Workers’ Compensation Benefits	$40.00
LIBC-764	Notice of Change of Workers’ Compensation Disability Status	$40.00
LIBC-765	Impairment Rating Evaluation Appointment	$40.00
LIBC-766	Request for Designation of a Physician to Perform an Impairment Rating Evaluation	$40.00
LIBC-767	Impairment Rating Determination Face Sheet	$40.00