Free F242-388-000 state fund claims address change request - Washington

Labor and Industries Claims Administration PO Box 44291 Olympia WA 98504-4291

STATE FUND CLAIMS ADDRESS CHANGE REQUEST
Claim Number:

NAME

Effective Date for your New Address:

New Residential Address:

City

State

ZIP+4

Is your MAILING ADDRESS the same as above? Yes

No

New Mailing Address (if different than Residential Address):
City State ZIP+4

Telephone number, including area code: Signature Today's Date

PLEASE NOTE that you must notify Labor and Industries of your new address right away to prevent a delay of benefits. You may also update your address on-line at the Claim and Account Center . Mail: Claims Administration Department of Labor and Industries P.O. Box 44291 Olympia, WA 98504-4291 Fax: Notify your claim manager before sending the fax. Use any of the following numbers:
· · ·

360-902-4565 360-902-4566

360-902-4567 Call 1-800-LISTENS or your claim manager if you have questions.
F242-388-000 state fund claims address change ­ 01-2008

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