Free Adobe PDF - Illinois


File Size: 31.2 kB
Pages: 1
File Format: PDF
State: Illinois
Category: Workers Compensation
Word Count: 77 Words, 799 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.iwcc.il.gov/attycodeform.pdf

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ILLINOIS WORKERS' COMPENSATION COMMISSION 100 WEST RANDOLPH STREET #8-200 CHICAGO, IL 60601-3227 312-814-6500 WWW.IWCC.IL.GOV APPLICATION FOR IWCC ATTORNEY CODE NUMBER

Attorney Firm Name Address Suite/P.O. Box City, State, Zip E-mail Address Telephone

__________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________

Illinois ARDC Registration Number _________________________ RETURN TO: Yvonna Castronova Public Information Unit Illinois Workers' Compensation Commission 100 W. Randolph St. #8-200 Chicago, IL 60601 [email protected] Assigned Attorney Code number Date Assigned _________________________ _________________________

8/06