STATE OF OKLAHOMA COUNTY OF ___________________________ OKLAHOMA WORKERS' COMPENSATION COMMISSION 440 S HOUSTON STE 212 TULSA, OK 74127 COMMISSION FILE NO.:_________________________________ In Re Claim of: __________________________________________________ Claimant (Employee) __________________________________________________ Respondent (Employer) __________________________________________________ Insurance Carrier, Own Risk Group or Individual Self-Insured TO: __________________________________________________ Name of Person Being Served __________________________________________________ Street Address/Post Office Box __________________________________________________ City/State/Zip/Telephone YOU ARE COMMANDED TO: SUBPOENA ) ) ) ) ) ) ) ) ____ To appear in person ____ To produce document or object Party requesting subpoena: ____ Claimant ____ Respondent/Carrier [NOTE TO PARTIES NOT REPRESENTED BY COUNSEL: Subpoenas may be produced at your request, but must be signed and issued by the Workers' Compensation Commission] _____________________________________________________________ Alternate Address _____________________________________________________________ City/State/Zip/Telephone (CHECK ALL THAT APPLY) _____ Appear and testify in the above captioned contested case at the place, date and time indicated below. _____ Appear and testify, in the above captioned contested case, at a deposition at the place, date and time indicated below. _____ Produce, permit inspection and copying of the following items at the place, date and time indicated below. _________________________________________________________________________________________________________________ _______________________________________________________________________________________ __________________________ _________________________________________________________________ ________________________________________________ _________________________________________________________________________________________________________________ Name and Location Where to Appear/Produce: Name: ___________________________________________ Location: _________________________________________ _________________________________________________ ___________________________________________________ Date and Time to Appear/Produce ___________________________________________________ Date ___________________________________________________ Signature of Person Issuing Subpoena ____ Commission Clerk (if requesting party has no attorney) ____ Administrative Law Judge ____ Attorney __________________________________________________ Name of Person Issuing Subpoena (Please print.) Name of Person Requesting Subpoena: _________________________________________ ____________________ Name Title _______________________________________________________________ Street/Post Office Box ____________________________________________________________ City/State/Zip _____________________________________________________________ Telephone Number _____________________________________________________________ DELIVER "RETURN OF SERVICE" TO PERSON NAMED ABOVE RETURN OF SERVICE I certify under penalty of perjury that this subpoena was received and served as follows: [NOTE TO PERSON REQUESTING SUBPOENA: A copy of Date Received By Authorized Server: _____________________ this subpoena must be delivered or mailed to each party ____ By delivering a copy of this subpoena to the person named above. in the case or to their attorney, if any.] ____ By registered or certified mail, return receipt requested, on the party named above. ____ This subpoena WAS NOT served for the following reasons:______________________________________________________________________ Date Served: _____________________ Revised 9-14-16 American LegalNet, Inc. www.FormsWorkFlow.com Signature and Title of Authorized Server: ______________________________________________________ Name of Authorized Server (Please print.):____________________________________________________