2144 - Served 2244 - Not Served 2344 - Served By Mail (Rev. 12/21/04) CCL 0036 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - LAW DIVISION ___________________________________________________ v. Illinois Workers' Compensation Commission of Illinois and __________________________________________________ } No. _______________________________ SUMMONS TO ILLINOIS WORKERS' COMPENSATION COMMISSION WORKER'S COMPENSATION REVIEW To the Illinois Workers' Compensation Commission of Illinois: YOU ARE SUMMONED and required, pursuant to a request for review filed by _______________________ __________________________________________________________________________________________________ on ____________________________, _______, to certify to this court on __________________________, _______, a transcript of the proceedings had before you in Illinois Workers' Compensation Commission No. _________________ ____________________ in which a decision or award was rendered on _____________________________, _______, by you for ________________________________________________________________________________________ and against ____________________________________________________________________________________. Atty. No.: __________________ WITNESS _____________________________, ________ Name: _______________________________________ Atty. For: _____________________________________ Address: _____________________________________ ______________________________________________ DOROTHY BROWN, Clerk of Court City/State/Zip: _____________________________ Date of service _____________________________, ________ Telephone: ___________________________________ (To be inserted by officer on copy left with Illinois Workers' Compensation Commission) **Service by Facsimile Transmission will be accepted at: __________________________________________________ (Area Code) (Facsimile Telephone Number) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form