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Rule 1.301, Form No. 17

IN THE WORKERS' COMPENSATION COURT OF THE STATE OF OKLAHOMA (Name of Claimant) Claimant, v. (Names of Respondent(s)) Respondent(s). ) ) ) ) ) )

Workers' Compensation Court No. ) Supreme Court No.

NOTICE OF COMPLETION OF WORKERS' COMPENSATION COURT RECORD FOR REVIEW BY SUPREME COURT

I certify that the record on appeal has been completed on this date and is ready for transmission to the Supreme Court, and that I have this date given notice in writing to that effect to all parties to the action, or to their counsel of record as listed below, by mailing a copy of this notice to them by First Class U.S. Mail. Dated this day of (month) , . (year)

(signature of Clerk) (Name of Court Clerk), Court Clerk Workers' Compensation Court Copies to: Clerk of the Supreme Court (Name of Claimant or Counsel of record). (Names of Respondents or their counsel of record).