STATE OF ILLINOIS ) ) COUNTY OF ______________ ) ILLINOIS WORKERS COMPENSATION COMMISSION ORDER _____________________________________________ Case # ______ WC __________________ Employee/Petitioner v. _____________________________________________ Employer/Respondent The petitioner ____ respondent ____ filed a petition or motion for ________________________ on ___________________ , and properly served all parties. The matter came before me on ___________________ in the city of _________________________________ . After hearing the parties arguments and due deliberations, I hereby grant ____ deny ____ the petition. A record of the hearing was ____ was not ____ made. FINDINGS OF FACT AND CONCLUSIONS OF LAW: This order is interlocutory and therefore not appealable. ____________________________________________________ __________________________ Signature of arbitrator Date IC34o 12/04 100 W. Randolph Street #8-200 Chicago, IL 60601 312/814-6611 Toll-free 866/352-3033 Web site: www.iwcc.il.govDownstate offices: Collinsville 618/346-3450 Peoria 309/671-3019 Rockford 815/987-7292 Springfield 217/785-7084 American LegalNet, Inc. www.USCourtForms.com