Missouri > Workers Comp
Substitution Of Counsel WC-237 - Missouri
| Substitution Of Counsel Form. This is a Missouri form and can be used in Workers Comp . |
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MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS 3315 West Truman Blvd., P.O. Box 58 Jefferson City, MO 65102-0058 INJURY NUMBER SUBSTITUTION OF COUNSEL + , Employee vs. , Employer and , Insurer , Third Party Administrator SUBSTITUTION OF COUNSEL On behalf of the Employee Employer/Insurer Third Party Administrator ) ) ) ) ) ) ) ) ) ) ) ) ) ) - Date of Accident/ Occupational Disease: COMES NOW, the undersigned attorneys and request substitution of counsel in the above case. Respectfully Submitted, Entering Firm/Attorney or Co-Counsel Signature Attorney Name Law Firm Address Phone No. Fax No. Bar No. E-mail Address Comments/Statements: Withdrawing Firm/Attorney or Co-Counsel Signature Attorney Name Law Firm Address Phone No. Fax No. Bar No. E-mail Address CERTIFICATE OF SERVICE I certify that a copy of this Substitution of Counsel was mailed or hand delivered to all parties of record, or if represented by an attorney, to their attorneys of record this day of , 20 . Attorney's Signature Attorney's Name (Printed) Address (if different than above) Bar No. Date DIVISION USE ONLY DATE STAMP + WC-237 WC-237 (04-12) AI American LegalNet, Inc. www.FormsWorkFlow.com
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