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In order to ensure that your workers' compensation claim is processed correctly, it is important to understand and complete the WB42 form. This document is used by insurance providers to determine benefits that may be due to an injured worker. The form can be complex, so it's important to know what information is required in order to receive the appropriate benefits. By understanding the WB42 form, you can ensure that your workers' compensation claim is handled efficiently and accurately.

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Question	Answer
Form Name	Wb42
Form Length	1 pages
Fillable?	Yes
Fillable fields	43
Avg. time to fill out	8 min 51 sec
Other names	wi amendment contract, wisconsin wb 42, wb 42, wb 42 amendment to listing contract

12

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Approved by the Wisconsin Real Estate Examining Board 11-1-09 (Optional Use Date) 3-1-10 (Mandatory Use Date)

WB-42 AMENDMENT TO LISTING CONTRACT

1It is agreed that the Listing Contract dated ________________________, ________, between the undersigned, for

2sale of the property known as (Street Address/Description) ___________________________________________

3in the ___________________________________ of _______________________________________, County of

4_____________________________________________________________ , Wisconsin is amended as follows:

5 The list price is changed from $_____________________________ to $ ____________________________.

6 The expiration date of the contract is changed from midnight ___________________________, ________ to

7midnight ___________________________________________________________________, __________.

8 The following items are (added to)(deleted from) STRIKE ONE the list of property to be included in the list

9price: _______________________________________________________________________________.

10_______________________________________________________________________________________

11 Other: _______________________________________________________________________________

12________________________________________________________________________________________

13________________________________________________________________________________________

14________________________________________________________________________________________

15________________________________________________________________________________________

16________________________________________________________________________________________

17________________________________________________________________________________________

18________________________________________________________________________________________

19________________________________________________________________________________________

20________________________________________________________________________________________

21________________________________________________________________________________________

22_______________________________________________________________________________________

23ALL OTHER TERMS OF THIS CONTRACT AND ANY PRIOR AMENDMENTS REMAIN UNCHANGED.

24CAUTION: Agents (salespersons) for Broker (firm) do not have the authority to enter into a mutual

25agreement to terminate a listing contract, amend the commission amount or shorten the term of a

26listing contract, without the written consent of the Agent(s)’ supervising broker.

27	__________________________________________		(x) ______________________________________
28	Broker/Firm	Date	Seller’s Signature 	Date
29			Print name
30	(x) __________________________________________		(x) ______________________________________
31	By 	Date	Seller’s Signature	Date
32	Print name		Print name

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The software will expect you to fill out the Sellers, Owners, Signature, Print, name Date, Sellers, Owners, Signature Print, name Date, and Date section.

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