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Stipulation And Award And Or Order WCAB 5 - California
| Stipulation And Award And Or Order Form. This is a California form and can be used in General Workers Comp . |
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STATE OF CALIFORNIA DIVISION OF WORKERS COMPENSATION WORKERS COMPENSATION APPEALS BOARD Applicant, v. Defendant(s). Having waived the provisions of Labor Code ยง5313, the parties stipulate as follows: Case No(s). STIPULATION and AWARD and/or ORDER ` ________________________________________ _______________________________________ Applicant Interpreter Attorney for Defendant _________________________________________ _______________________________________ Attorney for Applicant IT IS SO ORDERED/AWARDED IT IS ORDERED THAT: _______________________________________________________ If Expedited Hearing, enter as Final Findings & Award/Order. Dated: ____________________ Workers' Compensation Administrative Law Judge NOTICE TO: ____________________________________ Pursuant to Rule 10500, you are designated to serve this document on all parties shown on the Official Address Record, together with a proof of service. You shall maintain this proof of service, which shall not be filed with the WCAB unless a dispute arises regarding service. A copy of the current Official Address Record accompanies this notice. On _______________________, this document was personally served on all persons appearing at the hearing on said date, as set forth in the minutes of that hearing was personally served on ___________________________________________________ ___________________________________________________ ___________________________________________________ was served by mail on all persons listed on the Official Address Record was served by mail on following party or parties: ___________________________________________________ ___________________________________________________ ___________________________________________________. By _________________________________________________ DWC WCAB Form 5 (New 10/2005) American LegalNet, Inc. www.USCourtForms.com
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