Free 11.4.4 NMAC - New Mexico


File Size: 11.7 kB
Pages: 1
Date: January 29, 2007
File Format: PDF
State: New Mexico
Category: Workers Compensation
Author: Renee Blechner
Word Count: 66 Words, 941 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://workerscomp.state.nm.us/downloads/docs/disqualify.pdf

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STATE OF NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION

___________________________________________, Worker, v. ____________________________________________, and. ____________________________________________, Employer/Insurer.

WCA No.___________

NOTICE OF DISQUALIFICATION The ____ Worker_____ Employer,_________________________________________________________________ (Name of filing party) gives notice that Judge________________________________________________________ is disqualified from adjudicating this cause.

____________________________________ Name ____________________________________ Address ____________________________________ City/State/Zip (___)______________ (___)____________ Telephone & Fax Number

I certify a copy of this Notice of Disqualification was mailed to all parties this date___________________________. ________________________________________ (Signature of party mailing notice.)

11.4.4.9.18.2.G NMAC