California > Workers Comp > General

Unrepresented Additional Panel Proof Of Service - California

Unrepresented Additional Panel Proof Of Service Form. This is a California form and can be used in General Workers Comp .
 Fillable pdf Last Modified 1/22/2014
Get this form for FREE as a print-only pdf

Proof of Service By Mail I declare that: I am a resident of or employed in the county where the mailing took place. I am over the age of eighteen years, my business or residence address is: On , I served the attached Additional Panel Order the in said case, by placing a true copy thereof enclosed in a sealed envelope with postage thereon fully paid, in the United States mail, addressed as follows: Division of Workers' Compensation-Medical Unit P.O. Box 71010 Oakland, CA 94612 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that this declaration was executed on: Date: at , California. City Type or print name Signature _____________________________________________ Finding Order (Additional Panel QME-Unrepresented)-2014 American LegalNet, Inc. www.FormsWorkFlow.com
Link/Embed this Document
URL
Embed


Popular Searches

  1. Affidavit of Indigency
  2. petition for summary administration
  3. VERIFICATION
  4. case management statement
  5. order of protection
  6. default
  7. Civil Case Cover Sheet
  8. quit claim deed
  9. lien
  10. cover sheet

Bookmark and Share