___________________________________ Petitioner vs. THE ILLINOIS WORKERS' COMPENSATION COMMISSION AND before ____________________________, 20___, in the above entitled proceeding, in the office of the Clerk of this Court; and the Illinois Workers' Compensation Commission shall, on or before ________________, 20___, certify and file, in the above entitled proceeding, in the office of the Clerk of this Court, a transcript of the proceedings had before the Commission, in Workers' Compensation Commission No. ______________, in which a decision or award was rendered on ______________, 20___, by the Workers' Compensation Commission of Illinois for _________________________________________and against __________________________________________. , 20 NAME ___________________________ ATTORNEY FOR ___________________ ADDRESS_________________________ _________________________ TELEPHONE ______________________ On ______________, 20____, in accordance with law, I mailed a copy of this Summons, postage prepaid, to the office of the Illinois Workers' Compensation Commission and to the following parties in interest of their attorney or attorneys of record: , 20 American LegalNet, Inc. www.USCourtForms.com