COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. : JUDICIAL SUBPOENA Plaintiff(s) INDUSTRIAL COMMISSION P. O. BOX 83720: -againstBOISE, ID 83720-0041 : I.C. CASE NO. ________________ : I.C. CASE NAME _____________________________________________ Defendant(s) : ...................................................... _____________________________________________________ REPORT YORK THE PEOPLE OF THE STATE OF NEWOF LITIGATION EXPENSES (CLAIMANTS' ATTORNEY) TO In accordance with the requirements of Section 72-528, Idaho Code, this form shall be filled out and returned to the GREETINGS: Industrial Commission within 30 days following the time of entry WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court of a final award by the Industrial Commission in the above case, located at County of inor, in the , event of day ofappeal to a final court, in the room on the , 20 , at o'clock within noon, and at any recessed an 30 days or adjourned date, to testify and give evidence as a witness in this action on the part of the following a final ruling by the court. If there is an appeal, the totals specified below shall include the expenses, costs, or 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 fees incurred in the appeal. result of your failure to comply. 1. Attorneys fees incurred in litigation and charged Witness, Honorable to claimant: Court in County, day of , one of the Justices of the $_____________________ , 20 2. Expenses incurred in litigation and charged to claimant: TOTAL $_____________________ below) (Attorney must sign above and type name $_____________________ Attorney(s) for Dated this ________ day of _______________, 20____. Office and P.O. Address FIRM NAME ____________________________________________ Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: BY____________________________________________________ IC Form 1022 IDAPA 17.02.05.281 American LegalNet, Inc. www.USCourtForms.com