Free IC29 - Illinois

ILLINOIS WORKERS' COMPENSATION COMMISSION STIPULATION TO SUBSTITUTE ATTORNEYS
ATTENTION, PETITIONER : please attach a copy of the Attorney Representation Agreement.

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Employee/Petitioner

Case # ______ WC __________________

v. _____________________________________________
Employer/Respondent

I, _____________________________________ , want the attorney, ___________________________________ , to appear on my behalf in this case.
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Signature of petitioner or respondent

I hereby withdraw as the attorney for the above party.
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Signature of attorney

____________________________________________
Name of attorney and IC attorney code # (please print)

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Name of law firm

I hereby enter my appearance as the attorney for the above party.

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Signature of attorney

____________________________________________
Name of attorney and IC attorney code # (please print)

____________________________________________
Street address

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City, State, Zip code

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Date

IC29 6/08 100 W. Randolph Street #8-200 Chicago, IL 60601 312/814-6611 Toll-free 866/352-3033 Web site: www.iwcc.il.gov Downstate offices: Collinsville 618/346-3450 Peoria 309/671-3019 Rockford 815/987-7292 Springfield 217/785-7084