Get Illinois Workers Compensation Commission Notice Of Motion And Order Form

ILLINOIS WORKERS COMPENSATION COMMISSION NOTICE OF MOTION AND ORDER ATTENTION. You must attach the motion to this notice. If the motion is not attached this form may not be processed* Case WC Employee/Petitioner v* Employer/Respondent TO or as soon thereafter as possible I shall appear before the Honorable or any arbitrator or commissioner appearing in his or her place at Illinois and present the attached motion for Change of venue Consolidation of cases 3071 list case Fees under Section 16 Reinstatement of case Request for hearing R33 Hearing under Sect. 19 b 1902 Dismissal of attorney Withdrawal of attorney 3073 Penalties under Sect. 19 k 1911 Other explain Signature Petitioner Respondent Street address Attorney s name and IC code please print City State Zip code Name of law firm if applicable Telephone number E-mail address O RDER The motion is set for hearing on Signature of arbitrator or commissioner Date Granted Continued to Denied Dismissed Set for trial date certain on IC4 12/04 100 W* Randolph Street 8-200 Chicago IL 60601 312/814-6611 Toll-free line 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 P ROOF OF S ERVICE If the person who signed the Proof of Service is not an attorney this form must be notarized* in the city of a copy of this form at AM Signature of person completing Proof of Service Signed and sworn to before me on Notary Public The Workers Compensation Commission assigns code numbers to attorneys who regularly practice before it. To obtain or look up a code number contact the Information Unit in Chicago or any of the downstate offices at the telephone numbers listed on this form* IC4 page 2. If the motion is not attached this form may not be processed* Case WC Employee/Petitioner v* Employer/Respondent TO or as soon thereafter as possible I shall appear before the Honorable or any arbitrator or commissioner appearing in his or her place at Illinois and present the attached motion for Change of venue Consolidation of cases 3071 list case Fees under Section 16 Reinstatement of case Request for hearing R33 Hearing under Sect. 19 b 1902 Dismissal of attorney Withdrawal of attorney 3073 Penalties under Sect. 19 k 1911 Other explain Signature Petitioner Respondent Street address Attorney s name and IC code please print City State Zip code Name of law firm if applicable Telephone number E-mail address O RDER The motion is set for hearing on Signature of arbitrator or commissioner Date Granted Continued to Denied Dismissed Set for trial date certain on IC4 12/04 100 W* Randolph Street 8-200 Chicago IL 60601 312/814-6611 Toll-free line 866/352-3033 Web site www. 19 b 1902 Dismissal of attorney Withdrawal of attorney 3073 Penalties under Sect. 19 k 1911 Other explain Signature Petitioner Respondent Street address Attorney s name and IC code please print City State Zip code Name of law firm if applicable Telephone number E-mail address O RDER The motion is set for hearing on Signature of arbitrator or commissioner Date Granted Continued to Denied Dismissed Set for trial date certain on IC4 12/04 100 W* Randolph Street 8-200 Chicago IL 60601 312/814-6611 Toll-free line 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 P ROOF OF S ERVICE If the person who signed the Proof of Service is not an attorney this form must be notarized* in the city of a copy of this form at AM Signature of person completing Proof of Service Signed and sworn to before me on Notary Public The Workers Compensation Commission assigns code numbers to attorneys who regularly practice before it.