Free CCL 0038 11-01-04 - Illinois

2838 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, LAW DIVISION

(Rev. 11/01/04) CCL 0038

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v.

Illinois Workers' Compensation Commission of Illinois and

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No. _____________________________

CERTIFICATE OF MAILING WORKER'S COMPENSATION

On _________________________________________, ________, I mailed a copy of the summons to the Illinois Workers' Compensation Commission of Illinois, 100 West Randolph Street, Chicago, Illinois, and on the same date I mailed copies to the parties and attorneys at the address as follows:

Parties in interest

Attorneys of record

Dated: ____________________________, ________

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DOROTHY BROWN, Clerk of the Circuit Court DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS