Form No. 9 - Petition For Review - Supreme Court Of The State Of Oklahoma Page 3

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CERTIFICATE OF FILING AND MAILING
I ___________________________, do hereby certify that on this _____ day of
_________, 20_____, I did cause to be filed with the Workers' Compensation Court, a correct
copy of the Petition for Review with attachment(s), and also mailed a copy with attachment(s) to
each party to the proceeding or his counsel of record as follows:
[Names and addresses of all parties or counsel of record]

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