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Unemployment Compensation Notice Of Appeal To Missouri Court Of Appeals Form. This is a Missouri form and can be use in Court Of Appeals Appellate Courts.
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Tags: Unemployment Compensation Notice Of Appeal To Missouri Court Of Appeals, 8-C, Missouri Appellate Courts, Court Of Appeals
APPENDIX E
FORM NO. 8-C WORKERS’ COMPENSATION
NOTICE OF APPEAL
TO MISSOURI COURT OF APPEALS
__________________ DISTRICT
BEFORE THE LABOR AND INDUSTRIAL RELATIONS COMMISSION
STATE OF MISSOURI
)
)
)
) Injury No.____________________________________
)
) Appellate Court No.___________________________
Claimant,
vs.
)
)
)
Employer.
Notice is hereby given that _______________________________ appeals to the Missouri Court of Appeals,
_____________________ District.
___________________________________
_____________________________________________
Date notice of Appeal filed (to be filled in by
Secretary of Commission)
Signature of Attorney or Appellant
(The appellant(s) must file the original notice of appeal and one copy for the Appellate Court with, and pay the docket fee required by court rule to, the
secretary of the commission within the time specified by law. At the same time appellant must serve a copy of the notice of appeal on attorneys of
record of all parties other than appellant(s), and on all parties not represented by an attorney. Proof of service shall be made on the original and copy to
be filed with the commission. )
CASE INFORMATION
TYPE NAME AND BAR ENROLLMENT
NUMBER OF APPELLANT’S ATTORNEY
TYPE NAME AND BAR ENROLLMENT
NUMBER OF RESPONDENT’S ATTORNEY
_____________________________________
Street________________________________
City__________________________________
State_______________ Zip Code__________
Telephone____________________________
TYPE NAME OF APPELLANT
_____________________________________
Street________________________________
City__________________________________
State_______________ Zip Code__________
Date of Commission Award or Decision:
_____________________________________
________________________________________
Street___________________________________
City_____________________________________
State________________ Zip Code____________
Telephone_______________________________
TYPE NAMES OF
Employee:_______________________________
Dependents:______________________________
Employer:________________________________
Insurer:__________________________________
Date and County of Accident:_________________
________________________________________
________________________________________
Second Injury Fund Involved: YES____ NO____
*List additional respondents on page two of this form
(Attach copy of Commission Award or Decision)
DIRECTIONS TO COMMISSION
A copy of the notice of appeal and the docket fee shall be mailed forthwith to the clerk of the appellate court. The record on appeal shall be prepared
and certified within such time as to enable timely filing by the appellant.
PROOF OF SERVICE
I have this day served a copy of this notice of appeal on each of the following persons at the address stated by __________________________
(ordinary mail, certified mail, personal service):
_____________________________________________
Signature of Attorney or Appellant
Dated: _______________________, 19____
28
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