Free Workers' Compensation Subpoena For Deposition (WC-25-B-AI) (Fillable and Printable) - Missouri

MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS DIVISION OF WORKERS' COMPENSATION 3315 West Truman Blvd., P.O. Box 58 Jefferson City, MO 65102-0058

INJURY NUMBER

SUBPOENA FOR DEPOSITION
THE STATE OF MISSOURI, To

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You are hereby commanded to be and appear personally at (location) , at the hour of on (date) , in the City of , Missouri, to be deposed and testify regarding a Claim for Compensation under the Missouri Workers' Compensation Law between , employee (or dependent), , employer, and , insurer, at the request of party ­ employee, employer, insurer, or second injury fund) and hereof fail not at your peril.
This Subpoena is requested by for code, is: (name of attorney), attorney (name of party). Attorney's phone number, including area . Attorney's fax number, including area code, is: .

M.,

(name of

By requesting issuance of this Subpoena, the attorney so requesting affirms and verifies compliance with the Missouri Rules of Civil Procedure regarding the scheduling of the deposition of this witness, including (but not limited to) compliance with Rule 57.03(b)(1), regarding the giving of written notice to all other parties of the time and place for taking the deposition, and the identity of the person to be examined.

Given by order of the Division of Workers' Compensation, Department of Labor and Industrial Relations, with the seal of the Division of Workers' Compensation of the Department of Labor and Industrial Relations of the State of Missouri affixed, at the City of day of . , Missouri, this

DIVISION OF WORKERS' COMPENSATION (SEAL) By
Director ­ Administrative Law Judge (Over)

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WC-25-B

WC-25-B (11-07) AI

RETURN STATE OF MISSOURI of

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day of

ss.

being duly sworn, on his oath states that he served the within subpoena in the City of Missouri, on the thereof to the within named , by delivering a true copy

Subscribed and sworn to before me, this My term expires

day of

Notary Public

WC-25-B-2 (11-07) AI