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FORM_SERVER_DATA /CLAIMS S32-Int-Clmnt 7000 64714934 783141 F S32-Int-Clmnt 2 S32-Int-Clmnt 0002 S32 Interest Letter to Claimant 01/01/2018 F T F F T 80 CLAIMS 00000000000000000000 Alan Hedge <PHONE /> <EXTENSION /> <FAX /> <EMAIL /> </USER_PROFILE> </SIGNATURE_PROFILE_XML> <REFRESH_FORM>F</REFRESH_FORM> <CATEGORY_CODE>0015</CATEGORY_CODE> <STATUS_CODE>0001</STATUS_CODE> <STATUS_DESC>Work In Progress</STATUS_DESC> <STATUS_DATE>05/15/2017</STATUS_DATE> <STATUS_LONG_DESC /> <SUPPORTS_ADDRESSEE>T</SUPPORTS_ADDRESSEE> <SUPPORTS_CC>F</SUPPORTS_CC> <TO_WITH_COVERSHEET>F</TO_WITH_COVERSHEET> <CC_WITH_COVERSHEET>F</CC_WITH_COVERSHEET> <CC_COVERSHEET_WATERMARK>F</CC_COVERSHEET_WATERMARK> <TEMPLATE_STATUS_CODE>05</TEMPLATE_STATUS_CODE> <PRINT_ORIENTATION>P</PRINT_ORIENTATION> <PRINT_DUPLEX>S</PRINT_DUPLEX> <PRINT_COLOR>C</PRINT_COLOR> <DISPLAY_P_KEY>F</DISPLAY_P_KEY> <SOURCE_CODE>01</SOURCE_CODE> <SOURCE_DESC>Internal</SOURCE_DESC> <USER_CHANGED_DB_DATA>F</USER_CHANGED_DB_DATA> <SOFT_LOCK>0</SOFT_LOCK> <CREATED_BY>23</CREATED_BY> <CREATED_DT>05/15/2017</CREATED_DT> <ASSIGNED_TO>23</ASSIGNED_TO> <ASSIGNED_DT>05/15/2017</ASSIGNED_DT> <DATA_REFRESHED>F</DATA_REFRESHED> <DOCUMENT_ID>Q5KZK6D6U5R1</DOCUMENT_ID> <DELIVERY_MODE> <DELIVERY_MODE_ROW> <DELIVERY_CODE>01</DELIVERY_CODE> <DELIVERY_DESC>ONLINE PRINT</DELIVERY_DESC> <VALID>T</VALID> </DELIVERY_MODE_ROW> <DELIVERY_MODE_ROW> <DELIVERY_CODE>02</DELIVERY_CODE> <DELIVERY_DESC>ONLINE EMAIL</DELIVERY_DESC> <VALID>F</VALID> </DELIVERY_MODE_ROW> <DELIVERY_MODE_ROW> <DELIVERY_CODE>03</DELIVERY_CODE> <DELIVERY_DESC>ONLINE FAX</DELIVERY_DESC> <VALID>F</VALID> </DELIVERY_MODE_ROW> </DELIVERY_MODE> <FILING_MODE /> <FILING_MODE_DESC /> <CLONE_OF_FSID /> <ATTACH_TO_FSID /> <PROCESSED>F</PROCESSED> <PROCESSED_DT /> <PROCESSED_BY /> <CANCELED>F</CANCELED> <CANCELED_DT /> <CANCELED_BY /> <ATTACH_COUNT>0</ATTACH_COUNT> <ATTACH_LIST /> <CS_FORM_CODE /> <CS_FORM_VERSION /> <FORM_DATA_DESC>S32-Int-Clmnt 64714934</FORM_DATA_DESC> <CC_COUNT>0</CC_COUNT> <DATA_XML_BLOCK> <DATA_BODY>  <CLAIMANT_NAME>JOHN SMITH</CLAIMANT_NAME>  <CLAIM_NO>64714934</CLAIM_NO>  <DATE_OF_INJURY>02/14/2011</DATE_OF_INJURY>  <EMPLOYER_NAME>HILLSIDE RECYCLING EQUIPMENT CORP</EMPLOYER_NAME>  <REVIEWER_NAME>Ann Formel</REVIEWER_NAME>  <REVIEWER_PHONE>3154536500</REVIEWER_PHONE>  <UNIT_ADDR>1045 7th NORTH STREET, LIVERPOOL, NY 13088-3100</UNIT_ADDR>  <UNIT_PHONE>3154536500</UNIT_PHONE>  <UNIT_NO>372</UNIT_NO>  <WCB_NO>G0383766</WCB_NO> <ATTORNEY_NAME>KEEVILY,SPERO-WHITELAW INC. </ATTORNEY_NAME> </DATA_BODY> </DATA_XML_BLOCK> <ADDRESSEE_CODE>0004</ADDRESSEE_CODE> <ADDRESSEE_XML> <ADDRESSEE code="0004" desc="WC Claimant" foreign="F" key_code="7000" key_value="64714934" office_unit="372" splittable="T" suppress="F" zipcode="11385"> <NAME>JOHN SMITH</NAME> <ADDR_LINE1>88-34 AUBREY AVENUE</ADDR_LINE1> <ADDR_LINE2 /> <ADDR_LINE3 /> <ADDR_LINE4></ADDR_LINE4> <CITY>RIDGEWOOD</CITY> <STATE>NY</STATE> <ZIP>11385</ZIP> <ZIP2 /> <COUNTRY /> </ADDRESSEE> </ADDRESSEE_XML> <CC> <CC_ROW> <ADDRESSEE_CODE>0005</ADDRESSEE_CODE> <ADDRESSEE_XML> <ADDRESSEE code="7000" key_code="7000" key_value="64714934" office_unit="" foreign="F" suppress="F" splittable="T" zipcode="10528" desc="Broker/Rep"> <NAME>KEEVILY,SPERO-WHITELAW INC. </NAME> <ADDR_LINE1>500 MAMARONECK AVENUE </ADDR_LINE1> <ADDR_LINE2 /> <ADDR_LINE3 /> <ADDR_LINE4 /> <CITY>HARRISON</CITY> <STATE>NY</STATE> <ZIP>10528</ZIP> <ZIP2 /> </ADDRESSEE> </ADDRESSEE_XML> </CC_ROW> </CC> <RETURN_ADDR_CODE>99</RETURN_ADDR_CODE> <RETURN_ADDRESS_XML> <ADDRESS fax="????" phone="3154536500"> <ADDR_LINE1>1045 7th NORTH STREET</ADDR_LINE1> <ADDR_LINE2>LIVERPOOL, NY 13088-3100</ADDR_LINE2> <ADDR_LINE3 /> <ADDR_LINE4 /> </ADDRESS> </RETURN_ADDRESS_XML> <ADDRESSEE_LIST> <ADDRESSEE_LIST_ROW> <ADDRESSEE_CODE>0004</ADDRESSEE_CODE> <ADDRESSEE_DESC>WC Claimant</ADDRESSEE_DESC> <MAIN>T</MAIN> </ADDRESSEE_LIST_ROW> </ADDRESSEE_LIST> <CC_LIST /> <ADDRESSES_LOOK_UP> <ADDRESSEES_DATA> <ADDRESSEE code="0004" key_code="7000" key_value="64714934" office_unit="372" foreign="F" suppress="F" splittable="T" zipcode="11385" desc="WC Claimant"> <NAME>SMITH JOHN</NAME> <ADDR_LINE1>88-34 AUBREY AVENUE</ADDR_LINE1> <ADDR_LINE2 /> <ADDR_LINE3 /> <ADDR_LINE4 /> <CITY>RIDGEWOOD</CITY> <STATE>NY</STATE> <ZIP>11385</ZIP> <ZIP2 /> </ADDRESSEE> </ADDRESSEES_DATA> </ADDRESSES_LOOK_UP> <USER_PROFILE_LOOK_UP> <DATA_BODY /> </USER_PROFILE_LOOK_UP> <PDF_STATE_ID>123823</PDF_STATE_ID> </ROW> </FORM_SERVER_DATA>