Proof Of Service {IC15}

ILLINOIS WORKERS COMPENSATION COMMISSION PROOF OF SERVICE ATTENTION. If the person who signed the Proof of Service is not an attorney, this form must be notarized. Service for documents related to Section 19(b-1) of the Workers Compe nsation Act must be made by personal service or certified mail. I, ___________________________________________________ , affirm that I _____ mailed a copy of this form with proper postage in the city of _ _________________ _____ sent a copy of this form by certified mail (return receipt requ ested) _____ delivered a copy of this form at _____________ on _____________________ to each party at the address listed below. __________________________________________________ Signature of person completing Proof of Service Signed and sworn to before me _____________________ _________________________________________________ Notary Public IC15 12/04 100 W. Randolph Street #8-200 Chicago, IL 60601 312/814-6611 Toll-free 866/352-3033 Web site: www.iwcc.il.govDownstate offices: Collinsville 618/346-3450 Peoria 309/671-3019 Rockford 815/987-7292 Springfield 217/785-7084 American LegalNet, Inc. www.USCourtForms.com