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Report Of Litigation Expenses (Employer-Surety-ISIF-Self Insureds) Form. This is a Idaho form and can be use in Attorney Workers Compensation.
Tags: Report Of Litigation Expenses (Employer-Surety-ISIF-Self Insureds), IC-1023, Idaho Workers Compensation, Attorney
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
-against-
Index No.
Calendar No.
INDUSTRIAL COMMISSION
:
JUDICIAL SUBPOENA
P.Plaintiff(s) 83720
O. BOX
BOISE, ID 83720-0041
:
:
I.C. CASE NO. ________________
:
I.C. CASE NAME _____________________________________________
Defendant(s)
:
. . . _______________________________________________________
...................................................
REPORT OF LITIGATION EXPENSES
(EMPLOYER/SURETY/ISIF/SELF INSURERS)
THE PEOPLE OF THE STATE OF NEW YORK
In accordance with the requirements of Section 72-528, Idaho Code,
this form shall be filled out and returned to the Industrial
TO
Commission within 30 days following the time of entry of a final
award by the Industrial Commission in the above case, or, in the
event of an appeal to a final court, within 30 days following a
final ruling by the court.
If there is an appeal, the totals
GREETINGS: below shall include the expenses, costs, or fees incurred
specified
in the appeal.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
1.
$_____________
,
the Honorable Attorneys fees paid in case:
at the
Court
located at
County of
_____________and at any recessed
in room 2. Expenses charged by attorneys:
, on the
day of
, 20
, at
o'clock in the
noon,
or adjourned date, to testify and give evidence as a witness in this action on the part of the
3.
Charges for reports or testimony
of witnesses:
_____________
4. Cost comply with this subpoena is taken:
_____________
Your failure to of any depositions 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
5. Cost of investigations made before
result of your failure to comply.
or during hearing:
_____________
Witness, Honorable
6. Costs of research or legal briefs
(if County,
separate day of attorneys fees):
from
Court in
, 20
7.
Filing fees paid on account of
the litigation:
, one of the Justices of the
_____________
_____________
(Attorney must sign above and type name below)
TOTAL
$_____________
Dated this _______ day of __________________, 19 ____.
Attorney(s) for
FIRM NAME_____________________________________________
BY____________________________________________________
Office and P.O. Address
Check Applicable Box:
___Self Insured
___ Uninsured Employer
___ Surety
___State Insurance Fund ___Industrial Special Indemnity Fund
IC Form 1023
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
IDAPA 17.02.05.281
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