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LB-0384 (REV 11/15) RDA 10183 Tennessee Bureau of Workers Compensation 220 French Landing Drive, I-B . Nashville, TN 37243-1002 . FORM C-41 .
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Form DEA-41 See instructions on reverse (page 2) of form. . REGISTRANT RECORD OF CONTROLLED SUBSTANCES DESTROYED. FORM DEA-41 . A. REGISTRANT INFORMATION . 3bb9090bfc