0026 Workers Compensation (This form replaces CCL 0036 A) (Rev. 11/01/04) CCL 0035 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - LAW DIVISION _____________________________________________ No. _________________________________ v. Illinois Workers Compensation Commission of Illinois and } _____________________________________________ REQUEST TO THE CLERK OF THE CIRCUIT COURT This is a written request to issue summons to the Illinois Workers C ompensation Commission at 100 W. Randolph St., Chicago, Illinois, and to Parties and Attorneys at below addresses. Pur suant 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: Atty. No.:____________________________ City/State/Zip: _______________________________ Telephone: __________________________________ **Service by Facsimile Transmission will be accepted at: ____________________________________________ (Area Code) (Facsimile Telephone Number) American LegalNet, Inc. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS www.USCourtForms.com