Free CCL 0036 12-21-04 - Illinois

2144 - Served 2244 - Not Served 2344 - Served By Mail IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - LAW DIVISION

(Rev. 12/21/04) CCL 0036

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v. Illinois Workers' Compensation Commission of Illinois and

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No. _______________________________

SUMMONS TO ILLINOIS WORKERS' COMPENSATION COMMISSION WORKER'S COMPENSATION REVIEW
To the Illinois Workers' Compensation Commission of Illinois: YOU ARE SUMMONED and required, pursuant to a request for review filed by _______________________

__________________________________________________________________________________________________
on ____________________________, _______, to certify to this court on __________________________, _______, a transcript of the proceedings had before you in Illinois Workers' Compensation Commission No. _________________

____________________ in which a decision or award was rendered on _____________________________, _______,
by you for ________________________________________________________________________________________ and against ____________________________________________________________________________________.

Atty. No.: __________________ Name: _______________________________________ Atty. For: _____________________________________ Address: _____________________________________ City/State/Zip: _____________________________ Telephone: ___________________________________

WITNESS _____________________________, ________

______________________________________________
DOROTHY BROWN, Clerk of Court Date of service _____________________________, ________
(To be inserted by officer on copy left with Illinois Workers' Compensation Commission)

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

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