!C99Shell v. 1.0 pre-release build #13!

Software: Apache/2.0.54 (Unix) mod_perl/1.99_09 Perl/v5.8.0 mod_ssl/2.0.54 OpenSSL/0.9.7l DAV/2 FrontPage/5.0.2.2635 PHP/4.4.0 mod_gzip/2.0.26.1a 

uname -a: Linux snow.he.net 4.4.276-v2-mono-1 #1 SMP Wed Jul 21 11:21:17 PDT 2021 i686 

uid=99(nobody) gid=98(nobody) groups=98(nobody) 

Safe-mode: OFF (not secure)

/home/butwin/public_html/allstate/forms/specialty/   drwxr-xr-x
Free 318.35 GB of 458.09 GB (69.5%)
Home    Back    Forward    UPDIR    Refresh    Search    Buffer    Encoder    Tools    Proc.    FTP brute    Sec.    SQL    PHP-code    Update    Feedback    Self remove    Logout    


Viewing file:     WorkComp.doc (99 KB)      -rw-r--r--
Select action/file-type:
(+) | (+) | (+) | Code (+) | Session (+) | (+) | SDB (+) | (+) | (+) | (+) | (+) | (+) |
ࡱ>	%`	*cbjbj"x"x	6@@<	<	<	<	<	<	<	P	%%%%|&P	uJB$((.(.(.(.22|_3@[A]A]A]AAAEI$KhNI]<	 722 7 7I<	<	(.(./J::: 7
<	(.<	(.[A: 7[A::';<	<	O;(.()=%*7?;O;EJ0uJG;N@7|NO;N<	O;314h:4T43333II:
333uJ 7 7 7 7P	P	P	$t"P	P	P	t"P	P	P	<	<	<	<	<	<	/J60 Cutter Mill Road ( Suite 414
Great Neck, NY 11021
516-466-4200 (  HYPERLINK "http://www.butwin.com" www.butwin.com

fax  516-466-4213   no cover page needed


or exit, save and e-mail to allstate@butwin.com

WORKERS COMPENSATION
and DBL
 APPLICATION
       Press TAB to move between fields

Named Insured: FORMTEXT      DBA : FORMTEXT      Address: FORMTEXT      Agent FORMTEXT       FORMTEXT City, State, Zip: FORMTEXT      Contact FORMTEXT       FORMTEXT County: FORMTEXT       FORMTEXT  FORMTEXT E-mail FORMTEXT       FORMTEXT  FORMTEXT Township: (State of PA only) FORMTEXT       FORMTEXT  FORMTEXT Phone FORMTEXT       FORMTEXT  FORMTEXT Contact & Phone: FORMTEXT       FORMTEXT  FORMTEXT Fax FORMTEXT       FORMTEXT  FORMTEXT E-mail & Website: FORMTEXT       FORMTEXT  FORMTEXT  FORMTEXT  FORMTEXT  FORMCHECKBOX  Individual         FORMCHECKBOX  Partnership         FORMCHECKBOX  Corporation         FORMCHECKBOX  Other:  FORMTEXT      Entity is in business for: FORMTEXT      Years or    FORMCHECKBOX  NewCoverage Effective Date: FORMTEXT       FORMTEXT Describe all operations:   Type here&  FORMTEXT  FORMTEXT      
Fed Tax ID #: FORMTEXT       FORMTEXT  FORMTEXT Unemployment Registration #: FORMTEXT       FORMTEXT  FORMTEXT 
# of Full Time Employees (excluding owners): FORMTEXT      # OF Owners: FORMTEXT      # of Part Time Employees: FORMTEXT      Owners Annual Payroll or Draw:$  FORMTEXT       FORMTEXT total # of males: FORMTEXT      Annual Payroll (excluding owners):$  FORMTEXT      total # of females: FORMTEXT      Gross Receipts:$  FORMTEXT      EntBCDEhijxyz{		scSsK6OJQJ]5B*CJ OJQJ\]ph5B*CJOJQJ\]phB*CJ OJQJ]phj5CJU5B*CJOJQJphff356OJQJaJ
B*CJphff36CJOJQJaJ56B*CJOJQJaJph
B*CJphff30J>*B*CJphff3jB*CJUphff3jB*CJUphff3	jB*CJphff3
B*CJphff3 5z{eW$If]|kd$IfK$L$l@;	
t
0644
l`
ap
$$If]a$K$
$If]*c		veTTTe$($If]^(a$$($If]^(a$
$If]kd%$IfK$L$l@;	
t
0644
l`
ap
						/	0	=	?	@	J	K	





0
2
4
>
@
V
X
l
n
p
z
|
~














ùytOJQJjDUjU5CJOJQJjXUjUjUmHnHujU	jU5CJOJQJ\CJ]^J&56B*
CJOJQJ\^JaJph3 6B*
CJOJQJ^JaJph3B*
CJ]aJph36]\-		/	0	?	

B
qooee[e
(($If
($Ifkd$$IflF
+w

t0,644
laB
D
V
~


`VVIV
$($Ifa$
($Ifkdm$$Ifl\~	 +	x*x
t0G,C44
la


*l`QG:G
$($Ifa$
($If
!($Ifkd$$Ifl\~	H +	JF
t0G,M44
la
*,@BDNRfhj~$&*>@BX~jUjUjYUCJaJj8UjUj~Uj:UjUjUj_UjUjUmHnHu	jUjsU6ln~D`VVIV
$($Ifa$
($Ifkd$$Ifl\~	H +	JF
t0G,M44
laDFD
`VVIV
$($Ifa$
($Ifkd|$$Ifl\~	H +	JF
t0G,M44
la



$
&
*
>
@
B
h
j
~


















"$&*NPdfhrvj!Uj!Uj!UOJQJjUjUj0UjUjUj2UjUjUjUmHnHujWU	jU6D
F
h


(`VVIV
$($Ifa$
($IfkdU$$Ifl\~	H +	JF
t0G,M44
la(*N`QG:G
$($Ifa$
($If
!($Ifkd. $$Ifl\~	H +	JF
t0G,M44
la.0LNPxz (^`tvxëéj>*UmHnHujU'>*Uj>*UOJQJCJ
>*jU\mHnHujL%U\\jU\j$Ujd$Uj#Uj|#UjM"U	jUj	"U1`VFF
(($If
(($Ifkd"$$Ifl\~	H +	JF
t0G,M44
la "$&umbm$$Ifa$$Ifkd%$$IfF~	f!*	~	
t0G,"4
4Ha&(^<sdTTG=
(($If
$(($Ifa$
(($If
!(($Ifkd&$$IflFH +Hl
F
t0G,M44
la"68:>Bprx*,0DFHJ򐍃yj,CJUjx,CJUCJ
jCJUj,U5CJOJQJ\CJj*Uj*U]6CJOJQJ5OJQJ5;OJQJCJj(UjUmHnHuj?(U	jUj'U/<>@OA

<$Ifkd($$Ifr~	V$]+	,k
t0G,"~4
4Ha@B$Ifhkd)$$Ifl+G,
t0G,44
laJ{m`m
$($Ifa$($If^
($IfwkdJ+$$Ifl_+,	
t
0G,C44
lap
>@BDXZ\fhj¿}o}jCJaJjM0>*CJUaJj>*CJUaJmHnHuj/>*CJUaJ>*CJaJj>*CJUaJCJaJCJaJ;CJaJCJCJCJOJQJj-CJUjv-CJUCJ
jCJUjUmHnHu	jUj-U'2,
!kd-$$Ifl\b,t">+H	
t(0+44
lap(Bj|k]kkS
$If$If^$$If^a$dkd7/$$Ifo++
t0+4
4Ha
T	
 'T<$If^T`JO>0>>$If^$$If^a$kd0$$Ifr#S)o+L"w
t0+4
4Ha
JNPdfhrtv"$&*,@BDNPV~Ѹƣѕː}oj6>*CJUaJj4>*CJUaJCJaJCJaJj4>*CJUaJj2CJUaJjCJUaJjw2>*CJUaJCJaJ;CJaJ>*CJaJj>*CJUaJmHnHuj>*CJUaJj2>*CJUaJ+E4&$If^$$If^a$kd;3$$Ifr#S)o+L"w
t0+4
4Ha
$If&RTV~4kds5$$Ifr#S)o+L"w
t0+4
4Ha
$If$$If^a$XNXPXlXnXpXzX|XXXXXXXXXXXXXYYYYY4Y{ӇoӇj;CJUaJj:CJUaJjCJUaJ^JaJj:UaJj9UaJaJ
jUaJUOJQJ:CJ
aJCJaJj57>*CJUaJCJaJ;CJaJ>*CJaJj>*CJUaJj>*CJUaJmHnHu)~
$If$$If^a$$If^OI$Ifkd7$$Ifr#S)o+L"w
t0+4
4HaNXBY~

x$If
!x$Iffkd8$$Ifo++
t0+4
4Haity has prior Workers Comp  insurance: FORMCHECKBOX Yes   FORMCHECKBOX No %  If yes,  FORMCHECKBOX 1yr    FORMCHECKBOX 2yrs    FORMCHECKBOX 3yrsDo we have copy of current policy? FORMCHECKBOX Yes   FORMCHECKBOX No %  If yes, submit with app  % Current Carrier: FORMTEXT       FORMTEXT % If NO in-force COVERAGEDescribe each employee s job function
Annual Payroll

 FORMTEXT      
$  FORMTEXT 
 FORMTEXT      


 FORMTEXT      
$  FORMTEXT 
 FORMTEXT      


 FORMTEXT      
$  FORMTEXT 
 FORMTEXT      


 FORMTEXT      
$  FORMTEXT 
 FORMTEXT      


 FORMTEXT      
$  FORMTEXT 
 FORMTEXT      




Does the owner want to be included? FORMCHECKBOX Yes   FORMCHECKBOX NoPOLICY HISTORY & LOSS INFORMATIONHas your insurance been cancelled or non-renewed in the past three years: FORMCHECKBOX  FORMCHECKBOX Yes    FORMCHECKBOX No % If yes, explain: FORMTEXT      Has the insured had any claims in the last 3 years? FORMCHECKBOX Yes    FORMCHECKBOX No
Previous CarriersPremium# ofClaimClaim DescriptionClaim DateClaimsAmount FORMTEXT      $  FORMTEXT       FORMTEXT      $  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      $  FORMTEXT       FORMTEXT      $  FORMTEXT       FORMTEXT       FORMTEXT      

4Y6Y8YDYYYYYYYYYYYYYYZZZ>Z@ZTZVZXZbZfZzZ|Z~ZZZZZZZZZ([*[ַֽtnejCJU^J6CJ^J56;OJQJ]56OJQJ]CJ^JCJj>UjUmHnHuj=U	jUCJ^JaJ
56aJ^JaJj/=UaJj<UaJaJ
jUaJOJQJCJaJjCJUaJjy;CJUaJ'BYDYYZ>ZZqdVEV$
x$Ifa$

x$If
!x$Ifkd;$$Ifl0>+''2
t0+^12
2
44
lapZZZ8*

x$Ifkd]>$$Ifl\#>+'''"'(
t0+^12
2
2
2
44
lap(ZZZ

x$Ifqkd?$$Ifl>+'L+
t0+^12
44
lap
ZZ[&[}i$
($Ifa$K$
($IfK$qkdZ@$$Ifl>+'L+
t0+^12
44
lap
&[([P[p[[[yhhhW
($IfK$
<$IfK$kd
A$IfK$L$l0(#&+##
t044
lap*[>[@[B[L[N[P[T[V[j[l[n[p[r[[[[[[[[[[[[[[[[[[[[[[[[\
\\\&\(\*\4\6\8\<\>\R\ҽҙj<FCJU^JjDCJU^JjoDCJUaJjCCJU^JjpBCJU^Jj,BCJUaJjCJUaJCJaJjCJU^JmHnHujCJU^JjACJU^JCJ^J1[[[[4##
<$IfK$kdB$IfK$L$l\(#h$:*&+##@	
t044
lap([\\
($IfK$
<$IfK$\\8\X\4##
<$IfK$kd)E$IfK$L$l\(#h$:*&+##@	
t044
lap(R\T\V\X\Z\n\p\r\|\~\\\\\\\\\\\\\\\\\\\\\\\]]]]] ]$]&]:]<]>]@]B]V]갤가j8KCJUaJjJCJU^Jj9ICJU^JjHCJUaJCJaJjHCJU^JjCJU^JmHnHujFCJU^JjCJU^JCJ^JjCJUaJjFCJUaJ-X\\\
($IfK$
<$IfK$\\\\4##
<$IfK$kdlG$IfK$L$l\(#h$:*&+##@	
t044
lap(\\\
($IfK$
<$IfK$\\ ]@]4##
<$IfK$kdI$IfK$L$l\(#h$:*&+##@	
t044
lap(V]X]Z]d]f]l]n]r]t]]]]]]]]^^
^^^^^^X^Z^^^___0_2_4_@_B_^_`_b_h_j____¸®̦xu^JjQUjpQUj,QU	jU>*OJQJ>*CJOJQJCJ5CJOJQJjNUaJjMNUaJaJ
jUaJCJaJCJ^JCJ^JjCJU^JmHnHujCJU^Jj|KCJU^J+@]h]j]
($IfK$
<$IfK$j]l]n]4#
($IfK$kdK$IfK$L$l\(#h$:*&+##@	
t044
lap(n]p]r]
($IfhkdM$IfK$L$lK(#h$@0##4
lap
r]t]]^

x$IfqkdM$$Ifl>+'L+
t0+^12
44
lap
^^^vl
<$Ifkd5O$$Ifl0>+'2
t0+^12
44
lap^^Z^\^-fkdP$$Ifl+x+
t0+c44
la$IffkdP$$Ifl+x+
t0+c44
la\^^____|rr
$IfykdXR$$Ifl0|)s
t0+44
la
$If_____$`&`B`D`F`R`T`p`r`t`|`~`.a0a2aFaHaJaTaVaXa\a^aratavaaaaaaaaaaaaaaaýßýýßÚý~ßýýpjY>*CJUaJj	Y>*CJUaJjX>*CJUaJCJaJj>*CJUaJmHnHujX>*CJUaJ>*CJaJj>*CJUaJ5CJaJCJ
jTUj,TUjUmHnHu	jUjRU,__$`z`zpp
$IfkdmS$$Ifl0>+(
t0+144
lapz`|`~```````arllr]lT	$$Ifa$
T@$If$If$
T@$Ifa$ykdU$$Ifl0's~	
t0+i44
la	aa kdU$$Ifl4F֞-B%*`@```
`
t0>644
laf4aa
aaa(a*a,a	$$Ifa$$If
T@$If$
T@$Ifa$,a.a kdV$$Ifl4F֞-B%* @   
 
t0>644
laf4.a0aXaaaab(b$
T@[($If^[`a$
T@[($If^[`aaaaaaaaaaabbbbb$b&b(b,b.bBbDbFbPbRbTbXbZbnbpbrb|b~bbbbbbbbbbbbbbbbbbbھڰڢڔچjc]>*CJUaJj\>*CJUaJjm\>*CJUaJj[>*CJUaJjuZ>*CJUaJjY>*CJUaJ>*CJaJCJaJj>*CJUaJmHnHuj>*CJUaJ3(b*b#kdZ$$IflF֞-B%*@

t0>644
la*b,bTbbbbb$c$
T@[($If^[`a$
T@[($If^[`bbbbbbbccc c"c$c*cjY^>*CJUaJ>*CJaJj>*CJUaJmHnHuj>*CJUaJj]>*CJUaJ
$c&c(c*c#]kd^$$IflF֞-B%*@

t0>644
la4&PP/R / =!@"#@$h%DyKyK../../$IfK$L$q!vh5;#v;:Vl	
t
065;`
p
$IfK$L$q!vh5;#v;:Vl	
t
065;`
p
	DdiF

C"A
logobo%æO*N7]+KnC%æO*N7]+PNG


IHDRw9 uPLTEHtHHHtHt"""+++333888BBBHHHHtHHHttHJJJRRRZZZccckkksssttHtttHHttHt{{{ss{3{"8BJ"+38ZHHHHt88BcBJRZccksss{{tƽƽƌƔƭƜΜΥνΥέֵֵֽ֭޽ߜHtߜWtRNS׆bKGDHcmPPJCmp0712Hs:IDATx^휍o!A׮ P(;cqB8	Y)k\2w#/S2z[<wBȶ9p^y!t^c`΢MN/oL,gˌ|ޥ0^CX4MYI=*s
)fogëՁrK_>̣FZȭ<q=KD6!>s];<;$9;>;-!p!Ms̀p+?.9ng,;\w*X$LWSrhovU>|21oFkq^2
(NdIqx|+c>DiWpf(˟ -۵<T~T+p9agGϐ&*݂PΉ9⎈!P?ZC/gV/EM8pb呹X-aS|0[>9\lF&0Ü}m3SÞyC\
1k!aWjF͍|ۭ9|#rWL_ɌxB8UtܓjwZ9|.e~RN8O֔%>eRV#a;џQOk8^RFH5;FzHv{ےwZ@oH%/͝Ӛ8ͲHM4%8D**͌;9в,|kJEmSӥ?&E/s24*A
7$v/eoYSէQUF!ܻͅ4.j.#wၱ;T@g(/8q?yf(%@{pׇs2	)ˁD0$fω	=5"hĪKsko3w؉MK#ytb6Rn	Q=0
=cpta-u?>켵9IJ8Я!|A|~Ko1.oxh>9@ykJ19Pe蟹9PdA_b-E&ҝ5#g&΁֣yCf~iSqsA'6zۻWn*Ϟ59ng\imN?00}s=~1__"_7vOhw`+PbAU%g((j}9$J*D}m+_DcHZ*ɱ;÷l!~}(CcAhNk|>K29BʐP}	2G/C^BkZ/DV;<hKf7u]IGЬvV752z=GF"V3zqU3\KV9ktu@&d
ZnQOWijQ͌~L^1Y+Qj+ hdC8CՉ98*L@
/CL1a,j:a"A-:Bl"y5+FT$\ۄ
R$H[
bD7=$KyX|h:)M:dkxv4MHƂԨ]ڴ<vBvԴi
"'@tEI&E,uN;6U
fZM$Vm޿ےpAzYZ/zavdڸtnq8̄"os`v<WCԐ0) <[v1jX6X[>z2xM}CR=|0PV)9tX^V<z}n7b73`), PJ
s	ӵ_J"DFƠHb$<zp8X:P"fe,du:*9\,Q=0<9B2C1;;μ`4G\}QlQHVAsqCDz@r`AWJ
=Xehy5C/6U	(0:C8iRxN_iIEp<
vI-ARqA	Hw8!ͧn024*L!gx|hO
HZ5UqI*q-4N&͡6.-<l7BӞQk[D}u(VY09/Xʔ(h%-F8/&8 iދp&kqhHγ_+	ys583vN^J19\#z,CрRv6V)5d2b;8l~eiRvb
	]Mi*[ثזӲm6~%&245œftMMdqJ#jYv$]CZ>#3Cp\s=A1#z%J`ã0ʾ90pNǯ?O=B9ǎBrE|8&/łN(EqNWoS8S=</|("/`:}ǟއE?%cϐV{D[?/8*`cHg@'Y|p9p88?[}8>EŇ/;~_PG!F$?oV
GTR6Q99xjNW'7Ahg(IENDB`$$If!vh5w
55#vw
#v#v:Vl
t0,65w
55vDvDvDvD$$If!vh5	5x5*5x#v	#vx#v*#vx:Vl
t0G,C,5	5x5*5x///vDvDvDText71DD$$If!vh5	55J5F#v	#v#vJ#vF:Vl
t0G,M,5	55J5F///vDvDvDText33DD$$If!vh5	55J5F#v	#v#vJ#vF:Vl
t0G,M,5	55J5F//vDvDDDDDvDvDDDDD$$If!vh5	55J5F#v	#v#vJ#vF:Vl
t0G,M,5	55J5F//vDvDDDDDvDvDDDDD$$If!vh5	55J5F#v	#v#vJ#vF:Vl
t0G,M,5	55J5F//vDvDDDDDvDvDDDDD$$If!vh5	55J5F#v	#v#vJ#vF:Vl
t0G,M,5	55J5F//vDvDDDDDDDDD$$If!vh5	55J5F#v	#v#vJ#vF:Vl
t0G,M,5	55J5F///tDeCheck2tDeCheck2tDeCheck2tDeCheck2vDText69$$If!vh5	55~	#v	#v#v~	:V
t0G,",5	55~	//4H4$$If!vh5H5l
5F#vH#vl
#vF:Vl
t0G,M,5H5l
5F/vDText28tDeCheck1vDText39DD$$If!vh5	5,55k5#v	#v,#v#vk#v:V
t0G,"~,5	5,55k5//4H4$$If!vh5G,#vG,:Vl
t0G,,5G,/DDvDText70$$If!vh5,#v,:Vl_	
t
0G,C5,//p
vDText47DDDDvDText47DDDD7$$If!vh555H5#v#v#vH#v:Vl	
t(0+,555H5//p($$If!vh5+#v+:V
t0+,5+/4H4avDvDvDText14<$$If!vh5L5"55w5#vL#v"#v#vw#v:V
t0+,5L5"55w5//////4H4avDvDDText31#,##0DDJ$$If!vh5L5"55w5#vL#v"#v#vw#v:V
t0+,5L5"55w5///////4H4avDvDvDvDJ$$If!vh5L5"55w5#vL#v"#v#vw#v:V
t0+,5L5"55w5///////4H4avDvDvDvDJ$$If!vh5L5"55w5#vL#v"#v#vw#v:V
t0+,5L5"55w5///////4H4a$$If!vh5+#v+:V
t0+,5+//4H4atDeCheck3tDeCheck4tDeCheck3tDeCheck3tDeCheck3$$If^!vh552#v#v2:Vl
t0+^1,55292
2
aptDeCheck3tDeCheck4vDText39DD:$$If^!vh555"5(#v#v#v"#v(:Vl
t0+^1,555"5(9//2
2
2
2
ap($$If^!vh5L+#vL+:Vl
t0+^1,5L+9//2
ap
$$If^!vh5L+#vL+:Vl
t0+^1,5L+9/2
ap
$IfK$L$q!vh5##5#v###v:Vl
t05##5pvDText72DDvDText73$IfK$L$q!vh5##5@55#v###v@#v#v:Vl	
t05##5@55p(vDText72DDvDText73$IfK$L$q!vh5##5@55#v###v@#v#v:Vl	
t05##5@55p(vDText72DDvDText73$IfK$L$q!vh5##5@55#v###v@#v#v:Vl	
t05##5@55p(vDText72DDvDText73$IfK$L$q!vh5##5@55#v###v@#v#v:Vl	
t05##5@55p(vDText72DDvDText73$IfK$L$q!vh5##5@55#v###v@#v#v:Vl	
t05##5@55p($IfK$L$#!vh5@#v@:VlK0##5@4p
$$If^!vh5L+#vL+:Vl
t0+^1,5L+9/2
ap
tDeCheck3tDeCheck4$$If^!vh552#v#v2:Vl
t0+^1,5529/2
ap$$If!vh5x+#vx+:Vl
t0+c,5x+/a$$If!vh5x+#vx+:Vl
t0+c,5x+/aDDtDeCheck3tDeCheck4$$If!vh5s5#vs#v:Vl
t0+,5s5avDText68$$If!vh55(#v#v(:Vl
t0+1,55(/aptDeCheck3tDeCheck4$$If!vh5s5~	#vs#v~	:Vl
t0+i,5s5~	a'$$If!vh5@55555
5#v@#v#v#v#v#v
#v:Vl4F
t0>6+++++,5@55555
5f45$$If!vh5@55555
5#v@#v#v#v#v#v
#v:Vl4F
t0>6+++++,5@55555
5/f4vDText52DText53#,##0vDText54DText53#,##0vDText55jD$$If!vh5@55555
5#v@#v#v#v#v#v
#v:VlF
t0>6,5@55555
5/vDText52DText53#,##0vDText54DText53#,##0vDText55vDText62$$If!vh5@55555
5#v@#v#v#v#v#v
#v:VlF
t0>6,5@55555
5/@@@NormalOJQJ_HmH	sH	tH	:@:	Heading 1$5CJ:@:	Heading 2$6CJ>@>	Heading 3$$@&a$5Z@Z	Heading 4)$
T@T@&^T`58@8	Heading 5$@&5>@>	Heading 6$@&
5>*CJJ@J	Heading 7$P@&5>*CJOJQJL@L	Heading 8$<@&5CJOJQJL	@L	Heading 9	$<@&5CJOJQJDA@DDefault Paragraph FontVi@VTable Normal :V44
la(k(No ListXB@X	Body Text($
	T	
 X 'a$CJBP@BBody Text 2$a$
56CJpC@pBody Text Indent2$
h4 X 'T^T`a$CJ@@"@Header

!CJOJQJ:Q@2:Body Text 35CJrR@BrBody Text Indent 2/
hNP'T^T`CJ6U@Q6	Hyperlink>*B*ph@0@b@
List Bullet$a$FV@qFFollowedHyperlink>*B*phj@j
Table Grid7:V0 5z{/0?SYmnw9@no.2`asG[\]^_`{345Cq"#$>Rq/EFGHIsZk				.	>	R	S	T	h	x											






*
T
U
V
W
y
z

)*^"8L`abv00000 0 00 0 0 0 0000 0 000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 @0 0 0 0 0 0 0 0 0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 @0 @0 0 0 0 00 0 0 0 0 0 0 0  0  0  0 0 0  0  0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00Z			>	S	T	x							



*
T
U
00@h3;@d00Z00@	0.@W	@ Z00`X00`Z00+Z00		LRX00X00Z00		@00	 Z00Z00		@00	 Z00Z00		@00	 Z00Z00		@00	 Z00*X00`Z00hZ00`00 
00	4Y*[R\V]_ab*c!%(28<AIPS	B

lDD
(&<@~BYZZZ&[[[\X\\\\@]j]n]r]^^\^_z`aa,a.a(b*b$c*c "#$&')*+345679:;=>?@BCDEFGHJKLMNOQRT*c
Dix?KQYekw*+7@LRS_`l ,2>DEQR^s-=GSY{+1COUVbco >JPs1=Cs!'7kw}~					&	,	0	<	>	J	P	T	`	f	j	v	x																			*
:
@
P






!'^nu $068DJLX^bntxXFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFG$G$G$G$FTFG$FFFFFFFFFFFFFFFFFFFG,G,G,G,G,G,G,FFFFFFFFFFFFFFFFFG,G,G,G,G,FG,G,FFFF4FFFF4FF4FF@0e0e
   @ 5% 8c8c	

?1 d0u0@Ty2 NP'p<'pA)BCD|E||@0(	
B
S	?Text21Text71Text24Text22Text25Text39Text70Text14Text31Text72Text73Text74Text68Text53Text62xt			

2!		(

,|
,,
,#,<,,|&,%,|",|&&,/5	*.44A	:	*urn:schemas-microsoft-com:office:smarttagsStreet>*urn:schemas-microsoft-com:office:smarttags
PostalCode9*urn:schemas-microsoft-com:office:smarttagsphone;
*urn:schemas-microsoft-com:office:smarttagsaddress9*urn:schemas-microsoft-com:office:smarttagsState8*urn:schemas-microsoft-com:office:smarttagsCity9*urn:schemas-microsoft-com:office:smarttagsplacedx
5164664200
5164664213phonenumber
	35{0=?RSYlnw89@m-.2_asGZ{2345Cpq!$>Qqs1DIIZghhEUVWYYZU
W
z
())**\]^
!$78KL_buxd 5hh^h`OJQJo({0?SYmnw9@no.2`asG[\]^_`{345Cq"#$>Rq/EFGHIsZk				.	>	R	S	T	h	x											






*
T
U
V
W
y
z

)*^"8L`abv@\\Mobile1\1-HP LaserJet 4 PlusNe07:winspoolHP LaserJet 4 Plus\\Mobile1\1-HP LaserJet 4 Plus,C
odXXLetterDINU",e	SMTJHP LaserJet 4 PlusInputBinOption1RESDLLUniresDLLOrientationPORTRAITResolutionOption1PaperSizeLETTEREconomodeOption1RETOption1DuplexNONEHalftoneHT_PATSIZE_AUTO\\Mobile1\1-HP LaserJet 4 Plus,C
odXXLetterDINU",e	SMTJHP LaserJet 4 PlusInputBinOption1RESDLLUniresDLLOrientationPORTRAITResolutionOption1PaperSizeLETTEREconomodeOption1RETOption1DuplexNONEHalftoneHT_PATSIZE_AUTOLLDzL?L@{XLLLLLLP@P
PPPPPXUnknownG: Times New Roman5Symbol3&: Arial7&[ @VerdanaS&	Franklin Gothic Heavy"h5S&&)S&M

!24d2qHX(?2&Workers Compensation & DBL ApplicationRobert E. Butwin
Kim FloydeOh+'0D(	<H
ht
Robert E. Butwin8To offer comments, please send email to info@butwin.comNormal.dotKim Floyde16Microsoft Office Word@
@.OL@vM@v=
AButwin Insurance Group :: Workers Compensation & DBL ApplicationMicrosoft Office Word@
@.OL@vM@v=
AButwin Insurance Group :: Workers Compensation & DBL Application../../index.htmcationTitle 8@_PID_HLINKSAL//
../../../	

 !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry	F0fi@Data
V_1TableNWordDocument6SummaryInformation(
tDocumentSummaryInformation8<CompObjq	

	FMicrosoft Office Word Document
MSWordDocWord.Document.89q՜.+,D՜.+,Pht
$0<DTitle(Workers Compensation & DBL ApplicationButwin Insurance Group' <H_PID_HLINKSAAX//Oh+'0D(	<H
ht
Robert E. Butwin8To offer comments, please send email to info@butwin.comNormal.dotKim Floyde16

:: Command execute ::

Enter:
 
Select:
 

:: Search ::
  - regexp 

:: Upload ::
 
[ Read-Only ]

:: Make Dir ::
 
[ Read-Only ]
:: Make File ::
 
[ Read-Only ]

:: Go Dir ::
 
:: Go File ::
 

--[ c99shell v. 1.0 pre-release build #13 powered by Captain Crunch Security Team | http://ccteam.ru | Generation time: 0.0232 ]--