Free 11.4.4 NMAC - New Mexico

STATE OF NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION

__________________________________________, Worker, v. __________________________________________, and __________________________________________, Employer/Insurer.

WCA No.:___________________________

SUMMONS FOR APPLICATION TO WORKERS' COMPENSATION JUDGE TO: _______________________________________ _______________________________________ _______________________________________ ____________________________________ ____________________________________ ____________________________________

GREETINGS: You are directed to file a written response with the Clerk of the Workers' Compensation Administration within 10 days of receipt of this Application, and to mail a copy of the response to the filing party within the same time period. You are notified that, unless you serve and file a responsive pleading or motion, the Workers' Compensation Administration may enter a judgment against you for the relief demanded in the Application. Worker or filing party's representative: Address of Worker or filing party's representative: ___________________________________________ ___________________________________________ ___________________________________________

WITNESSED AND SEALED BY CLERK OF THE WCA (SEAL) By:_______________________________________________ Date:______________________________________________

(EACH RESPONDING PARTY MUST BE NAMED IN THE SUMMONS)

11.4.4.9.19.2.I NMAC