Free WKC17.PDF - Wisconsin

SUBPOENA

Department of Workforce Development Worker's Compensation Division 201 E. Washington Ave., Rm. C100 P.O. Box 7901 Madison, WI 53707-7901 Telephone: (608) 266-1340 Fax: (608) 267-0394 http://www.dwd.state.wi.us/wc/ e-mail: [email protected]

Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)].

State of Wisconsin County: _______________________________________ To:

Applicant

VS.

Respondent

Hearing Location (Include Room Number)

Hearing Date

Hearing Time

You are required to appear before the Department of Workforce Development on the day and at the time and place stated above, to give evidence in a controversy heard between the above named applicant and respondent, on the part of: Applicant Respondent You are further required to bring with you the following papers and documents: _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ The subpoena is issued pursuant to s. 102.17 (2) (2m) Wisconsin Statutes.

_________________________________________________________________________________________________ Law Firm or Person Issuing Subpoena

_________________________________________________________________________________________________ Mailing Address of Law Firm or Person (number, street, city, state, zip code)

_______________________________________________________________ Signature of Attorney or Person Issuing Subpoena
WKC-17 (R.07/2001)

________________________________ Date of Subpoena