SUMMONS – Industrial Commission IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS ______________________________________________ Petitioner vs. The Industrial Commission of Illinois and ______________________________________________ ______________________________________________ Respondents Case Number_________________________________ SUMMONS To each Respondent: You are hereby summoned and required to file your appearance on or before _____________________, 20_____, in the above entitled proceeding, in the office of the McHenry County Clerk of Court; and the Illinois Industrial Commission shall on or before ____________________________________, 20_____, certify and file, in the above entitled proceeding, in the office of the McHenry County Clerk of Court, a transcript of the proceedings had before the Commission, in Industrial Commission Number __________________________ in which a decision or award was rendered on _______________________________________, 20______, by the Industrial Commission of Illinois for ____________________________________________________________ __________________________________________________________________________________________ and against ________________________________________________________________________________ __________________________________________________________________________________________ WITNESS_____________________________ 20_______ ________________________________________________ Clerk of the Circuit Court Name___________________________________ Attorney for______________________________ Address__________________________________ City, State Zip_____________________________ Telephone________________________________ Note: Pursuant to law, proceedings for judicial review shall be commenced within 20 days of the receipt of notice of decision of the Commission. The summons shall be issued by the Clerk of Court upon written request returnable on a designated return date, not less than ten (10) or more than sixty (60) days from the date of issuance thereof. On _________________________________, 20_____, in accordance with law, I mailed a copy of this summons, postage prepaid to the Office of the Illinois Industrial Commission and to the following parties in interest of their attorney or attorneys of record: Respondent____________________________________________ Dated_____________________________, 20______ Address_______________________________________________ ___________________________________________ City, State Zip__________________________________________ Clerk of the Circuit Court CV-SUM7: Revised 12/01/06 American LegalNet, Inc. www.FormsWorkflow.com