Front:
THE INDUSTRIAL COMMISSION OF OHIO
NAME
JUN 10 1920
To the employer addressed:
Notices of injury have this day been filed by the following employes
of your Company and claim numbers assigned as below:
DATE OF INJURY
DEPARTMENT OF CLAIMS
0. Lether
Claim No.
750783
Date.
xx4-1-20
Risk No.
2687
IMPORTANT NOTICE TO EMPLOYER:-If you know of any irregularities in the above cases which may affect the right of the
claimant to receive an award, notify this Department immediately, giving details.
In case you have heretofore received notice of assignment of a claim number to any of the above, it indicates that duplicate
report has been filed, and this Department should be notified immediately. Claim number must appear on each blank filed.
Form C-14
Back:
OLUMBUS
JUN IO
4-PM
1920
OHIO
The G. C. Kuhlman Car Co
Cleveland, Ohio
E. 140th St.
ON
CENTS
