Free CCL 0039 10-29-04 - Illinois

3339

(Rev. 10/29/04) CCL 0039 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, LAW DIVISION

_________________________________________________
v. Illinois Workers' Compensation Commission of Illinois and

_________________________________________________

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No. _____________________________

BOND - CERTIORARI - WORKMEN'S COMPENSATION
On ________________________________, _________, an Award of $ __________________________ for __________________________________________________________________________________ against

________________________________________________________________________________ was rendered
by the Illinois Workers' Compensation Commission of Illinois, in Case No. _________________________________. A writ of certiorari has been issued by this court to review the award. The obligation of this bond is limited to $ __________________________________________

________________________________________ __________________________________________
As principal

_________________________________________
Approved:

_________________________________________
As surety

______________________________________, ________ _______________________________________________
Clerk of Court

Atty. No.: _______________ Name: _________________________________________ Atty. for: _______________________________________ Address: ______________________________________ City/State/Zip: ___________________________________ Telephone: _____________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS