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 |