Written Request For Summons And Notice Of Commencement Of Suit -Workers Compensation
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Written Request For Summons And Notice Of Commencement Of Suit -Workers Compensation Form. This is a Illinois form and can be use in Dupage Local County.
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Tags: Written Request For Summons And Notice Of Commencement Of Suit -Workers Compensation, 3512, Illinois Local County, Dupage
3512 (Rev. 01/06)
REQUEST FOR SUMMONS AND NOTICE OF COMMENCEMENT OF SUIT-WORKER'S COMPENSATION
UNITED STATES OF AMERICA
STATE OF ILLINOIS
COUNTY OF DU PAGE
IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT
CASE NUMBER
PLAINTIFF / PETITIONER
VS.
ILLINOIS WORKER'S COMPENSATION
COMMISSION
AND
DEFENDANT / RESPONDENT
File Stamp Here
WRITTEN REQUEST FOR SUMMONS AND
NOTICE OF COMMENCEMENT OF SUIT (WORKER'S COMPENSATION)
TO: CHRIS KACHIROUBAS, Clerk of the Eighteenth Judicial Circuit Court, DuPage County, Illinois
Please issue a Summons to the Illinois Worker's Compensation Commission to certify to this Court on
/
/
____________________ the transcript of all proceedings in the case of _
_
Illinois Worker's Compensation Commission No. _______________ . The decision of the Illinois Worker's
/
/
Compensation Commission was received by this petitioner and/or attorney on ___________________ . Also
issue a Summons directed to Petitioner-Respondent
and his attorney
/
/
returnable on ____________________ .
The names and last known address of the parties in interest and their respective attorneys are:
PARTIES IN INTEREST
ATTORNEYS OF RECORD
Illinois Worker's Compensation Commission
100 West Randolph Street
Suite 8-200
Chicago, Illinois 60601
PRO SE
Name:
DuPage Attorney Number:
Attorney for Petioner on Certiorari
Attorney for:
Address:
City/State/Zip:
Telephone Number:
CHRIS KACHIROUBAS, CLERK OF THE 18TH JUDICIAL CIRCUIT COURT ©
WHEATON, ILLINOIS 60189-0707
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