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-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


State of Pennsylvania Workers Compensation Forms in Word

Note, these forms are available from the State of Pennsylvania at this link: 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