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Bond-Certiorari-Workmens Compensation CCL-0039 - Illinois
| Bond-Certiorari-Workmens Compensation Form. This is a Illinois form and can be used in Law Cook Local County . |
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3339 (Rev. 10/29/04) CCL 0039 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, LAW DIVISION _________________________________________________ v. No. _____________________________Illinois Workers Compensation Commission of Illinois and } _________________________________________________ BOND - CERTIORARI - WORKMENS COMPENSATION On ________________________________, _________, an Award of $ __________________________ for __________________________________________________________________________________ against ________________________________________________________________________________ was rendered by the Illinois Workers Compensation Commission of Illinois, in Case No. _________________________________. A writ of certiorari has been issued by this court to review the award. The obligation of this bond is limited to $__________________________________________ ________________________________________ __________________________________________ As principal _________________________________________Approved: _________________________________________ As surety______________________________________, ________ _______________________________________________ Clerk of Court Atty. No.: _______________ Name: _________________________________________ Atty. for: _______________________________________ Address: ______________________________________ City/State/Zip: ___________________________________ Telephone: _____________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
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