Subpoena Form - Oklahoma Workers' Compensation Commission
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1STATE OF OKLAHOMA
OKLAHOMA WORKERS’ COMPENSATION COMMISSION
1915 N. STILES AVENUE
COUNTY OF ___________________________
OKLAHOMA CITY, OK 73105
COMMISSION FILE NO.:_________________________________
SUBPOENA
In Re Claim of:
__________________________________________________
)
____ To appear in person
____ To produce document or object
Claimant (Employee)
)
)
Party requesting subpoena:
__________________________________________________
)
____ Claimant
____ Respondent/Carrier
Respondent (Employer)
)
)
[NOTE TO PARTIES NOT REPRESENTED BY COUNSEL:
__________________________________________________
)
Subpoenas may be produced at your request, but must be signed and
Insurance Carrier, Own Risk Group or Individual Self-Insured
)
issued by the Workers’ Compensation Commission]
TO:
__________________________________________________
Name of Person Being Served
__________________________________________________
_____________________________________________________________
Street Address/Post Office Box
Alternate Address
__________________________________________________
_____________________________________________________________
City/State/Zip/Telephone
City/State/Zip/Telephone
YOU ARE COMMANDED TO:
(CHECK ALL THAT APPLY)
_____ Appear and testify in the above captioned contested case at the place, date and time indicated below.
_____ Appear and testify, in the above captioned contested case, at a deposition at the place, date and time indicated below.
_____ Produce, permit inspection and copying of the following items at the place, date and time indicated below.
_________________________________________________________________________________________________________________
_______________________________________________________________________________________ __________________________
_________________________________________________________________ ________________________________________________
_________________________________________________________________________________________________________________
Name and Location Where to Appear/Produce:
Name of Person Requesting Subpoena:
Name: ___________________________________________
Location: _________________________________________
_________________________________________ ____________________
_________________________________________________
Name
Title
___________________________________________________
_______________________________________________________________
Date and Time to Appear/Produce
Street/Post Office Box
___________________________________________________
____________________________________________________________
Date
City/State/Zip
___________________________________________________
Signature of Person Issuing Subpoena
_____________________________________________________________
____ Commission Clerk (if requesting party has no attorney)
Telephone Number
____ Administrative Law Judge
____ Attorney
_____________________________________________________________
__________________________________________________
DELIVER “RETURN OF SERVICE” TO PERSON NAMED ABOVE
Name of Person Issuing Subpoena (Please print.)
RETURN OF SERVICE
I certify under penalty of perjury that this subpoena was received and served as follows:
[NOTE TO PERSON REQUESTING SUBPOENA: A copy of
Date Received By Authorized Server: _____________________
this subpoena must be delivered or mailed to each party
____ By delivering a copy of this subpoena to the person named above.
in the case or to their attorney, if any.]
____ By registered or certified mail, return receipt requested, on the party named above.
____ This subpoena WAS NOT served for the following reasons:______________________________________________________________________
Date Served: _____________________
Signature and Title of Authorized Server: ______________________________________________________
Name of Authorized Server (Please print.):____________________________________________________
Revised 12-18-14
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