Maryland Workers Compensation Forms

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WORKERS’ COMPENSATION COMMISSION
10 EAST BALTIMORE STREET
BALTIMORE, MARYLAND 21202-1641
SUBPOENA
SUBPOENA DUCES TECUM
SUBPOENA DUCES TECUM for Medical Record*
*Issuing Party must prepare & attach a Certificate of Service pursuant to the Annotated
Code of Maryland, Health General, Section 4-306(b).
Claimant versus
WCC Claim Number
Employer
and
Insurer
ATTENTION: THIS FORM IS NO LONGER PRINTED IN DUPLICATE. IT IS THE RESPONSIBILITY OF THE PERSON ISSUING
THE SUBPOENA TO MAKE DUPLICATE COPIES FOR THE SHERIFF’S RETURN.
TO:
Name
Address
City
State
Zip Code
YOU ARE HEREBY COMMANDED TO PERSONALLY APPEAR
AND/OR
PRODUCE THE FOLLOWING:
at
, 20
on the
day of
at
A.M./P.M.
Subpoena requested by
; and any questions should be referred to:
Address
Telephone:
WORKERS' COMPENSATION COMMISSION
Date Issued
Per
SHERIFF’S RETURN
Served and copy delivered on date indicated below
Unserved, by reason of
Date: _______________________
SHERIFF
WCC Form H-08 (1/2015)
CLICK HERE TO CLEAR THE FORM

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