Notice Of Motion And Order - Illinois Workers' Compensation Commission Page 2
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2P
S
ROOF OF
ERVICE
If the person who signed the Proof of Service is not an attorney, this form must be notarized.
I, ________________________________ , affirm that I delivered _____ mailed with proper postage _____
in the city of _________________________________ a copy of this form
at
on
_ to each party at the address(es) listed below.
AM
___________
__________________
_____________________________________________
Signature of person completing Proof of Service
Signed and sworn to before me on _____________________
_____________________________________________
Notary Public
1
The Workers’ Compensation Commission assigns code numbers to attorneys who regularly practice before it. To obtain or look up a code
number, contact the Information Unit in Chicago or any of the downstate offices at the telephone numbers listed on this form.
IC4 page 2
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