Illinois > Workers Comp
Motion To Withdraw As Attorney Of Record IC28 - Illinois
| Motion To Withdraw As Attorney Of Record Form. This is a Illinois form and can be used in Workers Comp . |
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ILLINOIS WORKERS COMPENSATION COMMISSION MOTION TO WITHDRAW AS ATTORNEY OF RECORD _______________________________________________ Case # ________ WC ____________________ Employee/Petitioner v. _______________________________________________ Employer/Respondent I, ______________________________________________ , attorney for the p etitioner ____ respondent ____ , request permission to withdraw as the attorney of record on this case fo r the following reason: _____________________________________________ Signature of attorney _____________________________________________ Name of attorney and IC code number (please print) _____________________________________________ Date IC28 12/04 100 W. Randolph St. #8-200 Chicago, IL 60601 312/814-611 Toll-free 866/352-3033 Web site: www.iwcc.il.gov Downstate offices: Collinsville 618/346-3450 Peoria 309/671-3019 Ro ckford 815/987-7292 Springfield 217/785-7084 American LegalNet, Inc. www.USCourtForms.com
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