Corporate Executive Officer Termination Of Waiver
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Corporate Executive Officer Termination Of Waiver Form. This is a Nebraska form and can be use in Workers Comp.
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Tags: Corporate Executive Officer Termination Of Waiver, 10T, Nebraska Workers Comp,
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
To:
Index No.
:
Calendar NWCC Form 10T (Rev. 12/96)
No.
:
JUDICIAL SUBPOENA
:
Nebraska Workers’ Compensation Court
P.O. Box 98908
Plaintiff(s)
Lincoln NE 68509-8908
-against(402) 471-6468 (Lincoln & Outstate Only)
(800) 599-5155 (Nebraska Only)
(For Court Use Only)
:
:
Defendant(s)
:
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CORPORATE EXECUTIVE OFFICER — TERMINATION OF WAIVER
THE PEOPLE OF THE STATE OF NEW YORK
TO
Executive Officer Name
Corporation Name
Address
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
at the
Court
located at
County of
I wish to terminate on the
,
in room
, the executive officer waiver20
day of
, which at
, was filed about the
o'clock in
noon, and at any recessed
and adjourned subject to the provisions of theaNebraskathis action on the part of the Law.
or become date, to testify and give evidence as witness in Workers’ Compensation
Office Held in Corp.
the Honorable
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Date
(Officer Signature)
Witness, Honorable
Court in
County,
day of
, one of the Justices of the
, 20
(Attorney must sign above and type name below)
INSTRUCTIONS
1.
Attorney(s) for
Type or print in ink clearly. Original must be filed with the Court.
2.
A waiver may not be terminated until one year after the waiver has become effective.
3.
The termination becomes effective upon receipt by the Court.
4.
A copy of the termination must also be filed with the secretary of the corporation. Address
Office and P.O.
5.
It is advisable that you file one copy with your insurance company and retain one for your files.
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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