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Written Request For Summons And Notice Of Commencement Of Suit -Workers Compensation 3512 - Illinois
| Written Request For Summons And Notice Of Commencement Of Suit -Workers Compensation Form. This is a Illinois form and can be used in Workers Comp Dupage Local County . |
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R E QUES T FOR S UMMONS AND NOTICE OF COMMENCEMENT OF S UIT-WOR KER S COMP ENS ATION 3512 (Rev. 12/04) UNITED STATES OF AMERICA STATE OF ILLINOIS COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT CASE NUM BER PLAINTIFF VS. INDUSTRIAL COMMISSION OF ILLINOIS AND RESPONDENT File Stamp Here WR ITTEN REQUEST FOR SUM M ONS AND NOTICE OF COM M ENCEM ENT OF SUIT (WOR KERS COM PENSATION) TO: CHRIS KACHIROUBAS, Clerk of the Eighteenth Judicial Circuit Court, DuPage County, Illinois Please issue a Summons to the Industrial Commission of Illinois, to certify to this Court on , 20 , the transcript of all proceedings in the case of Industrial Commission No. the decision of the Industrial Commission was received by this petitioner and/or his attorney on , 20 . Also issue a Summons directed to Petitioner-Respondent: and his attorney: returnable on , 20 The names and last known addresses of the parties in interest and their respective attorneys are: PARTIES IN INTEREST ATTORNEYS OF RECORD Industrial Commission of Illinois 100 West Randolph Street Suite 8-200 Chicago, Illinois 60601 Name: PRO SE DuPage Attorney Number: Attorney for: Address: City/State/Zip: Notary Public-Circuit Court Clerk Telephone: CHRIS KACHIROUBAS, CLERK OF THE 18TH JUDICIAL CIRCUIT COURT WHEATON, ILL INOIS 60189-0707
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