LIEN DISCLOSURE FORM Forms
| Form Name | LIEN DISCLOSURE FORM |
| Form # | Form 116C |
| Form Revision | Revised 4/2024 |
| Category | Forms » Legal/Fraud |
| Downloads | |
| Form State | Massachusetts |
| Language | English |
| State Description | This form is filed at the lump sum conference. It is used by the employee to certify that there are no outstanding liens on the case, with any of the following parties: * the Department of Public |
| Claimwire Description | n/a |