Notice Of Third Party Action Employer Carrier {S-1}

COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Form No. S-1 1980 Index No. Calendar No. I.C. File No. JUDICIAL SUBPOENA Plaintiff(s) : The use of this form Is required under the provisions of the South Carolina Workers' Compensation Law. -against: NOTICE : OF Defendant(s) THIRD PARTY ACTION : ...................................................... EMPLOYER CARRIER THE PEOPLE OF THE STATE OF In the Workers' Compensation claim ofNEW YORK TO vs. , Employee , Claimant (s) : GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the, Carrier. Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed TO THE SOUTHdate, to testify and give evidence as a witness COMMISSION and the above named employee, or claimor adjourned CAROLINA WORKERS' COMPENSATION in this action on the part of the , Employer ant (s), and (any other person entitled to sue) I PLEASE Your failure to comply with this has been is punishable as a contempt of court and will make you liable to TAKE NOTICE that an action subpoena commenced against the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a as defendant (s) in the Court of result of your failure to comply. 9 County of Witness, Honorable under date of Court in County, and State of day of , 20 , one of the Justices of the (Attorney must sign above and type name below) Workers' Compensation Carrier or Self-Insurer Employer Attorney(s) for DATED: Attorney for Carrier or Self-insurer Employer Office and P.O. Address A copy of this form must be served upon the South Carolina Workers' Telephone No.:Commission, the injured employee or his Compensation surviving Workers' Compensation beneficiary and any other person entitled to sue the third party by personal service, registered Facsimile No.: or certified mail within ninety (90) days after statutory assignment that the right of action has passed to the carrier orsplf-insurer employer; and attached hereto is Form No. S-3 ''Entitlement to Right of Action'' E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com