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Summons To Industrial Commission Workers Compensation Review CCL-0036 - Illinois
| Summons To Industrial Commission Workers Compensation Review Form. This is a Illinois form and can be used in Law Cook Local County . |
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2144 - Served 2244 - Not Served 2344 - Served By Mail (Rev. 12/21/04) CCL 0036 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - LAW DIVISION ___________________________________________________ No. _______________________________ v. Illinois Workers Compensation Commission of Illinois and } __________________________________________________ SUMMONS TO ILLINOIS WORKERS COMPENSATION COMMISSION WORKERS COMPENSATION REVIEW To the Illinois Workers Compensation Commission of Illinois: YOU ARE SUMMONED and required, pursuant to a request for review filed by _______________________ ________________________________________________________________________ __________________________ on ____________________________, _______, to certify to this court on __________________________, _______, a transcript of the proceedings had before you in Illinois Workers Comp ensation Commission No. _________________ ____________________ in which a decision or award was rendered on _____________________________, _______, by you for ________________________________________________________________________ ________________ and against ________________________________________________________________________ ____________. Atty. No.: __________________ WITNESS _____________________________, ________ Name: _______________________________________ Atty. For: _____________________________________ ______________________________________________ DOROTHY BROWN, Clerk of Court Address: _____________________________________ City/State/Zip:_____________________________ Date of service _____________________________, ________ (To be inserted by officer on copy left with Illinois Workers Compe nsationTelephone: ___________________________________ Commission) **Service by Facsimile Transmission will be accepted at: __________________________________________________ (Area Code) (Facsimile Telephone Number) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS American LegalNet, Inc. www.USCourtForms.com
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