STATE OF NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION
__________________________________________, Worker, v. __________________________________________, and __________________________________________, Employer/Insurer.
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)