Free CCL 0035 11-01-04 - Illinois

0026 Worker's Compensation (This form replaces CCL 0036 A) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - LAW DIVISION

(Rev. 11/01/04) CCL 0035

_____________________________________________
v. Illinois Workers' Compensation Commission of Illinois and

_____________________________________________

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No. _________________________________

REQUEST TO THE CLERK OF THE CIRCUIT COURT
This is a written request to issue summons to the Illinois Workers' Compensation Commission at 100 W. Randolph St., Chicago, Illinois, and to Parties and Attorneys at below addresses. (Use additional sheet if more space is needed) Parties in interest Attorney of record Pursuant to 820 ILCS 305/19(f)(1) .

Date: ____________________________, _________ Atty. No.:____________________________________ Name: ______________________________________ Atty. for: ____________________________________ Address: Atty. No.:____________________________ City/State/Zip: _______________________________ Telephone: __________________________________

__________________________________________
(Signature of Attorney)

**Service by Facsimile Transmission will be accepted at: ____________________________________________
(Area Code) (Facsimile Telephone Number)

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS