Upon reading and filing the foregoing settlement and agreement and joint petition of the parties, and being fully advised in the premises, and it appearing that the allegations of said petition are true and that said settlement is substantially in accordance with the provisions of Part II of Chapter 467 of the Laws of Minnesota of 1913, and Sections 13 and 14 thereof,

IT IS ORDERED, That the said settlement, release and petition be, and the same hereby are approved, and that the parties in all things conform thereto.

The undersigned, being the only parties interested in the aboveentitled matter, hereby petition the Court for approval of the following agreement and settlement, and agree and represent the Court as follows:

That they are subject to the provisions of Part II of Chapter 467 of the Laws of Minnesota of 1913; that said Employé, aged.................. years, residing at....

.Street, .191.,

City of..... ..State of Minnesota, did, on...... at........o'clock....M., sustain injury while employed by said Employer, which injury occurred at

(Here state exactly where accident occurred.)

Minnesota

and resulted in the death of said Employé on..

191.; that

said deceased Employé was receiving at the time of the injury

wages at the rate of $...

.per week; that..

(Here state name, age, relationship and address of each dependent.)

and no others were his dependents at the date of his death who ..dependent upon him at the time of the injury;

were...

(Wholly or partially.)

and that of such dependents.

(Names of those who can read English.)

can, and..

cannot read (Names of those who cannot read English.)

and understand the English language; Therefore, it is hereby agreed that said dependents are entitled to and shall receive compensation for said injury and death from the Employer, beginning.. 191., at the rate of $........ per week in the aggregate, during dependency, payable as follows:.

all subject to the limitations of said Act; and the said dependents agree to give proper receipts for each payment made hereunder. The dependents hereby acknowledge that all medical and surgical treatment and benefits given by Section 18 of Part II of said Act have been furnished. This settlement is substantially in accordance with Sections 13 and 14 of said Act. When all payments hereunder have been made the Employer shall be, and hereby is, released from all claims on account of said injury and death under said Act or otherwise. This settlement contains the whole agreement between the parties hereto.

a Notary Public within and for said County and State, personally appeared..... .to me known to be the identical persons described in the foregoing instrument as dependents, and who executed said instrument as such, and each acknowledged that the same is true; and that, after reading the same (or) having the same read to him (or her), and with a full understanding of the terms and effect thereof, he (or she) executed the same as his (or her) free and voluntary act and deed for the uses and purposes therein expressed.

do hereby on my oath say, that I understand, read and speak readily the English language, and that I correctly read over to .dependents of said.. .deceased, and correctly interpreted to them (him or her) in their (his or her) own language, the true and correct meaning of each word in the foregoing instrument and the acknowledgment thereof; and that they (he or she) executed said instrument and acknowledged the execution of the same after I had interpreted and fully explained the same to them (him or her); and I further say that I am conversant with the language spoken by said dependents, which is that of.....

Subscribed and sworn to before me this

Upon reading and filing the foregoing settlement and agreement and joint petition of the parties, and being fully advised in the premises, and it appearing that the allegations of said petition are true and that said settlement is substantially in accordance with the provisions of Part II of Chapter 467 of the Laws of Minnesota of 1913, and Sections 13 and 14 thereof,

IT IS ORDERED, That the said settlement, release and petition be, and the same hereby are approved, and that the parties in all things conform thereto.

Dated at..

Minnesota,..

Judge of District Court .191..

NEBRASKA

The parties may settle all matters of compensation between themselves. § 36. In case of dispute the matter is submitted to arbitration if both parties agree. § 37. In case the parties do not agree to arbitrate the matter either party may file a petition in the District Court and power is given to this tribunal to hear the matter in a summary manner. § 39. Appeals are allowed as in other cases.

NEVADA 1

The Nevada Act provides for a State insurance fund ad1 PART I

RULES AND DIRECTIONS FOR EMPLOYERS

1. Whenever an accident occurs to any workman (in your mine, plant, or establishment) it shall be the duty of the employer to at once report

Nevada

ministered by the Nevada Industrial Commission. All such accident to the Commission, for which use Industrial Commission Blank No. 21. Blank reports for such purpose may be secured by applying for same to the Commission. These reports must be filled out accurately, immediately, and in detail as required by Section 33 of the law and the rules and regulations of the Commission.

2. Where an injured workman files a claim for compensation, it shall be the duty of the physician and also of the employer, to inform and advise the injured workman (or his relatives or dependents, in case of his death) of his rights under the Nevada Industrial Insurance Act, and to lend all necessary assistance in aiding the workman in making his claim and such proof as the Commission may require. Such assistance is to be "without charge to the workman," as required and provided in Section 34 of the law. Blanks for filing claims for compensation (Form Nos. 21 and 22) will be sent to the different employers, and if not, may be secured by writing to the Commission. Each employer should have these and other blanks on hand at all times so that prompt reports may be made to the Commission of all accidents.

3. Each employer should assist his injured employés in securing their rights under the law. The entire matter is between the employer, employé, and the Nevada Industrial Commission. In assisting your injured workmen and doing all that you can for their benefit or relief, you in no way injure or prejudice yourself. Such assistance will tend to produce more cordial relations between employer and workmen, and greatly expedite and facilitate the operation and administration of the law. In all matters of doubt or dispute address the Commission direct. No claim for compensation is valid unless filed within one year after date of injury, and all workmen should be so advised.

4. Section 29 of the law specifically provides that no employer of workmen shall exempt himself of the burden, or waive the benefits of the law, by any contract, rule, or regulation, and any such contract, rule, or regulation shall be void.

5. Employers should inform and advise their injured workmen that Section 28 of the law provides that no money paid or payable under the Nevada Industrial Insurance Act shall, prior to issuance and delivery of the warrant, be assigned, charged, or even be taken in execution, attached and garnished, nor shall be passed to any other person by operation of law. Any such assignment or charge shall be void.

or

6. Section 39 of the law relating to employer's responsibility for safeguards, and inflicting heavy penalties in case of injury due to the absence of safeguards, should be maintained, and all departmental rulings under any statute strictly observed. Otherwise serious penalties may be im