2145 - Served 2245 - Not Served (Rev. 11/01/04) CCL 0037 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, LAW DIVISION __________________________________________________ v. Illinois Workers’ Compensation Commission of Illinois and __________________________________________________ } No. _____________________________ SUMMONS TO RESPONDENT WORKER’S COMPENSATION REVIEW To _______________________________________________________________________, respondent, and ___________________________________________________________________________, attorney for respondent. YOU ARE SUMMONED and required to file your appearance in this case in the office of the clerk of this court located in Room 801, Richard J. Daley Center, Chicago, Illinois, on or before* _______________________________ ___________________________________, ________ and show cause why the decision or award of the Illinois Workers’ Compensation Commission of Illinois rendered on ______________________________, ________, for ____________________________________________________________________________________ against ______________________________________________________________________________________ should not be reversed. IF YOU FAIL TO DO SO, THE DECISION OR AWARD MAY BE REVERSED. Atty. No.:__________________ WITNESS ________________________, ________ Name: ____________________________________________ Atty. for: __________________________________________ ________________________________________ DOROTHY BROWN, Clerk of the Circuit Court Address: __________________________________________ City/State/Zip: _____________________________________ Telephone: _______________________________________ Date of service ________________________, ________ (To be inserted by officer on copy left with employer or other person) *10 to 60 days from date of issuance of this summons **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