MISSISSIPPI WORKERS' COMPENSATION COMMISSION MWCC NO. ____________________________________ ______________________________________________ VS ______________________________________________ AND ______________________________________________ CLAIMANT EMPLOYER CARRIER SUBPOENA FOR TAKING DEPOSITION STATE OF MISSISSIPPI COUNTY OF _________________________ TO THE SHERIFF OR OTHER PERSON AUTHORIZED TO SERVE SUBPOENAS: WE COMMAND YOU TO SUMMON: _____________________________________________ ________________________________________________________________________________ to personally appear for the taking of a deposition at: ______________________________________ ________________________________________________________________________________ ________________________________________________________________________________ on the _________ day of _________________, ______, at __________ o'clock ____.m. to give evidence in the above styled case, at the instance of: ______________________________________ ________________________________________________________________________________ ________________________________________________________________________________ GIVEN UNDER MY HAND AND SEAL OF OFFICE this the ____ day of ___________, _____ Commission Secretary This subpoena prepared by: ___________________________________ Attorney ___________________ (____)__________ Bar Identification No. Telephone _________________________________________ Address __________________________________________ City State Zip American LegalNet, Inc. www.FormsWorkFlow.com RETURN STATE OF MISSISSIPPI COUNTY OF _________________________ I hereby certify that I am eighteen years of age or older and am not a party to this case before the Mississippi Workers' Compensation Commission and I personally delivered a copy of the foregoing subpoena on the _________ day of _______________, _________ to: ________________________________________________________________________________ at the following address: ________________________________________________________________________________ ________________________________________________________________________________. This the _________ day of _______________, ________. ___________________________________________ Signature of person serving subpoena ___________________________________________ Typed or printed name ___________________________________________ Address ___________________________________________ ___________________________________________ Telephone American LegalNet, Inc. www.FormsWorkFlow.com