COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. BEFORE THE IOWA WORKERS’ COMPENSATION COMMISSIONER ____________________________________________________________________ : : JUDICIAL SUBPOENA Plaintiff(s) : -against: : Claimant, : : File No. ____________ : vs. : : : : : DISPUTE RESOLUTION Defendant(s) : . . . . . . . . Employer, . . . . . . . . . . . . . . . . . . . . . . .:. . . . . CONFERENCE REPORT .......... ........ : and : : THE PEOPLE OF THE STATE OF NEW YORK : : Insurance Carrier, : TO Defendants. : ____________________________________________________________________ The parties, GREETINGS: in compliance with the Order setting this matter for conference, report to the deputy that: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 1. Claimant (is) (is not) currently receiving weekly benefits. If not, state whether , the Honorable at the Court located benefits since the date of injury, when those benefits County ofclaimant has received any at ceased ,and why; or why benefits have not at been initiated, in the if applicable. and at any recessed in room on the day of , 20 , o'clock noon, or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in The principal dispute(s) inof matter is20 County, day this , (are): 2. , one of the Justices of the (Attorney must sign above and type name below) Attorney(s) for 3. The parties' contention for each disputed issue identified in paragraph 2, above, including a brief summary of the testimony expected to be presented to support Office and P.O. Address the contentions, is attached hereto. Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : 4. Index No. : The parties can, for the purposes of this conference Calendar No. that: only, agree Plaintiff(s) -against- : JUDICIAL SUBPOENA : : : 5. The parties wish to bring the following information to the deputy's attention: Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO 6. The parties certify that they have made a good faith attempt to settle the GREETINGS: disputed issues. See, rule 876 IAC 10.1. If no attempts have been made, the deputy may cancel the mediation. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Submitted by, ____________________________ __________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Claimant Attorney for Claimant the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. ___________________________ Witness, Honorable Representative of Court in County, Employer/Insurance Carrier day of 14-0041 09/98 _________________________________ , one of the Justices of the Attorney for Defendant , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com