Decision {IC34d}

STATE OF ILLINOIS ) ) COUNTY OF ______________ ) ILLINOIS WORKERS COMPENSATION COMMISSION DECISION _____________________________________________ Case # ______ WC __________________Employee/Petitioner v. _____________________________________________ Employer/Respondent The petitioner ____ respondent ____ filed a petition or motion for ________________________ on ___________________ , and properly served all parties. The matter came before me on ___________________ in the city of _________________________________ . After hearingthe parties arguments and due deliberations, I hereby grant ____ deny ____ the petition. A record of the hearing was ____ was not ____ made. FINDINGS OF FACT AND CONCLUSIONS OF LAW : Unless a Petition for Review is filed within 30 days from the date of receipt of this order,and a review perfected in accordance with the Act and the Rules, this order will be entered as the decision of the Workers Compensation Commission. ____________________________________________________ __________________________ Signature of arbitrator Date IC34d 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