Cal. Code Regs. tit. 8, § 9914 – Reproduction of Form 510, Notice of Employee Death.

(a) Employers and insurers may reproduce DIA Form 510, in which the heading may be rearranged to permit printing of:
1. (1) The insurance carrier's or employer's name, address and telephone number.
2. (2) Instructions for forwarding the form and number of copies required.
(b) The spacing, arrangement, sequence or language shall not otherwise be altered.

1. Amendment filed 7-11-73 as an emergency; effective upon filing. Certificate of Compliance included (Register 73, No. 28).