Petition To Reopen {DWC WCAB 42}

Department of Industrial Relations Division of Workers' Compensation WORKERS' COMPENSATION APPEALS BOARD STATE OF CALIFORNIA ) ) ) Applicant, ) ) ) ) ) ) Defendants ) Case No. vs. PETITION TO REOPEN Petitioner hereby requests that the above-entitled action be reopened for the following reasons: PROOF OF SERVICE (WCAB RULE 10514) On _____________ at ___________________ (date) (place) ____________________________________ Petitioner Copy mailed to following addresses: _____________________________________ ____________________________________ Address ____________________________________ Attorney for Petitioner ____________________________________ Address of Attorney _____________________________________ _____________________________________ ___________________________ (Signature) DWC/WCAB FORM 42 (REV. 8-85) American LegalNet, Inc. www.USCourtForms.com