Wage Claim Form - PDF
industrial commission of arizona labor department p.o. box 19070 phoenix, arizona 85005-9070 phone (602) 542-4515 fax 602-542-8097 wage claim no._____ (for office use only) amount $ _____ (for office use only) claimant information: *last name: *first name: mi: *d.o.b.: ................
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