Document gDOqb2vELkGebE1wkELO0DLa3

' r<no tMI-TSM-U-JI * STATE Ol OHIO Bureau of Workmens Compensation Duplicate-Record of Proceedings Eaptoye_____ .................................................................................................. Claim No..................... D-107210-TM- Street end No_^5\95~'i-.2-~.-"SfH:X>*t* of Injury............................................................. .Junc-.XliTL'957- City__________...................................................................................................Manual No-..................A233........................ <suti Employer____ Rhili^l. fiarC" Street and No.--iiVSJii..AYJ^ City_________ LcmKland-JJ^Ohio..___ ............ .................... .Risk No.. -165.4. 2l Present for Claimant. Present tor Employer---.___ ...____--__--____________________________ _ (Addn) On this day the above numbered claim, together with the proof on file, was presented to the Bureau, considered and a .lading was made as follows: "'hat this claim be disallowed, for the reason the Administrator finds the fill in;; of the claim application on December 6,1?3:> v/ar. not rx;dc '.ri.th.in the statutory tine of one year after the beifinnin.- of disability of June 1-,1957, nor within a period of oix months after the diagnosis of asbostoois on January 51955 and there is no jurisdiction to consider this clain. n- JiElkAJ-'C _______ an J' 9jr/a ^ #1-INSTRUCTIONS TO DELIVERING EMPLOYEE Deliver ONLY u> addrctK< 1") Show eddrew where 1--I delivered (AdtlHitaol rirfegei reemVcrf /r their lenKo; MTURN aiCilRT Received the numbered wide deecribed on other side, Date Janu3ry..l3^105.9..................................................................................... Admtnlctrttof