STATE OF NEW MEXICO WORKERS222 COMPENSATION ADMINISTRATION , WCA No.: Worker, v. , and , Employer/Insurer. SUMMONS FOR PETITION FOR LUMP SUM PAYMENT TO: GREETINGS: You are directed to appear before the Workers222 Compensation Administration and respond to this Petition. If you choose to file a written response to this Petition, you must file your response with the Workers222 Compensation Administration Clerk of Court within 10 days of receipt of this Petition If you fail to appear and respond, the Workers222 Compensation Administration may enter a judgment against you for the relief demanded in the Petition. Worker or filing party's representative: Address of Worker or filing party's representative: WITNESSED AND SEALED BY THE CLERK OF THE WCA American LegalNet, Inc. www.FormsWorkFlow.com