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Dispute Resolution Form (Stubbe Dakota Case Management) Form. This is a South Dakota form and can be use in Workers Compensation.
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Tags: Dispute Resolution Form (Stubbe Dakota Case Management), South Dakota Workers Compensation,
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
:
DISPUTE RESOLUTION FORM
JUDICIAL SUBPOENA
Plaintiff(s)
-against-
:
Date: _______________
:
From:
:
Name:
____________________
Defendant(s)
Address:
____________________
:
......................................................
____________________
THE PEOPLE OF THE STATE OF NEW YORK
TO
RE:
Telephone Number:
____________________
Claimant Name:
____________________
GREETINGS:
Date of Injury:
____________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable Number:
at the
Court
Claim
____________________
located at
County of
in room Employer: the
, on
day of ____________________
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Description and Summary of Dispute:
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.
______________________________________________________________________
______________________________________________________________________
Witness, Honorable
, one of the Justices of the
______________________________________________________________________
Court in
County,
day of
, 20
______________________________________________________________________
Please attach any supporting documentation that should be considered.
(Attorney must sign above and type name below)
Please submit to: The Administrator of the Certified Case Management Plan
Jerry Gravatt
Attorney(s)
Stubbe Dakota Case Management for
329-A East St. Joseph Street
Rapid City, SD 57701
Office issue within 30
It is the goal of the case management plan to resolve this and P.O. Address days of receipt
of this form. At that time, should resolution not be achieved, or there continues to be
dissatisfaction of the results, an appeal may be made to the South Dakota Department
Telephone No.:
of Labor.
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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