0026 Workers' Compensation IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - LAW DIVISION ____________________________________________________ v. Illinois Workers' Compensation Commission of Illinois and (5/9/16) CCL 0035 ___________________________________________ No. _______________________________________ REQUEST TO THE CLERK OF THE CIRCUIT COURT This is a written request to issue summons to the Illinois Workers' Compensation Commission at 100 W. Randolph St., Chicago, Illinois, and to Parties and Attorneys at below addresses. Pursuant to 820 ILCS 305/19(f )(1) .(Use additional sheet if more space is needed) Parties in interest Attorney of record Date: _____________________________________ __________________________________________ (Signature of Attorney) Atty. No.: ____________________ Name: _________________________________________ Atty. for: _______________________________________ Address: ________________________________________ City/State/Zip: ___________________________________ Telephone: ______________________________________ Primary Email: ___________________________________ Secondary Email: _________________________________ Tertiary Email: ___________________________________ **Service by Facsimile Transmission will be accepted at: ______________________________________________ (Area Code) (Facsimile Telephone Number) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 1