STATE OF NEW MEXICO WORKERS COMPENSATION ADMINISTRATION _____________________________, WCA NO:_____________________ Worker, VS. _____________________________, and Employer, _____________________________, Insurer, WAIVER OF SERVICE OF PROCESS I, ________________________, appearing for the Worker/Employer/Insurer waive my right to the service of process of the _________________________________ in the above captioned cause at: ___________________________________ ___________________________________ ___________________________________ Pursuant to Rules of Civil Procedure for the District Courts of New Mexico Rule 1-004. ________________________ Signature of the person waiving service of process ________________________ Relationship to Entity/ Authority to Receive Service of Process ________________________ Date of Signature