Notice Of Intent To File For Review In Circuit Court {IC25} | Pdf Fpdf Doc Docx | Illinois

 Illinois   Workers Comp 
Notice Of Intent To File For Review In Circuit Court {IC25} | Pdf Fpdf Doc Docx | Illinois

Last updated: 7/11/2013

Notice Of Intent To File For Review In Circuit Court {IC25}

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Description

ILLINOIS WORKERS' COMPENSATION COMMISSION NOTICE OF INTENT TO FILE FOR REVIEW IN CIRCUIT COURT Please submit two copies of this form. Case # Employee/Petitioner v. WC IWCC IWCC Case # Employer/Respondent I have filed a Notice of Intent to File for Review in Circuit Court with the Illinois Workers' Compensation Commission on . _________________________________________________ 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 IC25 7/13 100 W. Randolph Street #8-200 Chicago, IL 60601 312/814-6611 Toll-free line 866/352-3033 Web site: www.iwcc.il.gov American LegalNet, Inc. www.FormsWorkFlow.com

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