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Get CA DWC 10253.1 2010

D AT REGULAR HEARING. IT IS FURTHER ORDERED THAT THE PROOF OF SERVICE ORDERED ABOVE BE FILED WITH THE WCAB THE ASSIGNED WORKERS’ COMPENSATION JUDGE. OTHER DISPOSITION AND ORDERS SERVICE OF THIS DOCUMENT WAS MADE PERSONALLY UPON BY WCJ. DATE _____/_____/_____ WORKERS’ COMPENSATION ADMINISTRATIVE LAW JUDGE PAGE 4 DWC CA form 10253.1 (Rev 11/2008 9/2010) ONLY ON REQUEST OF PRE-TRIAL CONFERENCE STATEMENT CASE NO. EXHIBITS � � APPLICANT DEFENDANT � � LIEN CLAIMANT DESCR.

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