SUBPOENA FOR WITNESS VWC File No. Case of COMMONWEALTH OF VIRGINIA, VIRGINIA WORKERS' COMPENSATION COMMISSION To the Sheriff of the City/County of WE COMMAND that you summon: to appear before the Virginia Workers' Compensation Commission at on the day of , 20, at to give evidence on behalf of the in the controversy pending before this Commission between , Claimant, and , Defendants. Failure to appear as directed is punishable by the penalty prescribed by law. Witness, the Virginia Workers' Compensation Commission, this the day of , 20. VIRGINIA WORKERS' COMPENSATION COMMISSION IRIS C. PEACE, Clerk __________________________________ Fee for serving subpoena to be paid by: _______________________________________________________________________ ATTENTION SHERIFF: Please return notice of service to the Virginia Workers' Compensation Commission, Office of the Clerk, 1000 DMV Drive, Richmond, VA 23220. American LegalNet, Inc. www.USCourtForms.com