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APPORTIONMENT - WIDOW WITH CHILDREN ONLY


Name
Date of Injury
# of Children
AWW	66 2/3%	$0.00
	State Max	602.00

# of Children	COMP RATE	Widow's Rate	Remarriage Lump Sum	Rate Per Child	Tot Children	Tot W/C
0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
0	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Widow only	$0.00	$0.00	$0.00			$0.00
CHILDREN ONLY
# of Children	COMP RATE	Rate Per Child	Tot Rate For Children
0	$0.00	$0.00	$0.00
0	$0.00	$0.00	$0.00
0	$0.00	$0.00	$0.00
0	$0.00	$0.00	$0.00
0	$0.00	$0.00	$0.00

This sheet is designed to calculate the entitlements for Death claims involving widow and children who are wholy and actually dependent. It will provide the appropriate compensation rates for the average weekly wage entered and the year of the Injury/Death.