North Carolina Industrial Commission IC File # SUBPOENA FOR WITNESS Emp. Code # Carrier Code # The Use Of This Form Is Required Under The Provisions of The Workers' Compensation Act Employer FEIN Before the North Carolina Industrial Commission 430 North Salisbury Street Raleigh, North Carolina 27611 THE STATE OF NORTH CAROLINA To the Sheriff of County - Greetings: You are hereby commanded to summon to be and appear before the North Carolina Industrial Commission at the following location: County, City, Street Address, on , at o'clock to give evidence in a case then and there to be tried, wherein Plaintiff, , and Defendant(s) are parties. Physicians who are called to offer expert medical testimony are not required to appear at the above designated time; but instead, physicians are to stand-by from the time the case is scheduled and for the remainder of the business day. The physician will be telephoned at least 30 minutes before testifying. FAILURE TO COMPLY WITH THIS SUBPOENA MAY RESULT IN SANCTIONS AS PROVIDED BY LAW. Issued this day of . This subpoena is served at the request of: (List name of party and name of attorney, or if no attorney, so indicate) Date Received by Sheriff: Date Served by Sheriff: Sheriff SUBPOENA TO PRODUCE ITEMS OR DOCUMENTS Pursuant to the required appearance, you are hereby commanded to bring with you the following items or documents: (Describe with particularity) Signature/Title FORM 36 11/05 PAGE 1 OF 1 FORM 36 American LegalNet, Inc. www.USCourtForms.com