STATE OF NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION
_________________________________________________, Worker, v. _________________________________________________, and _________________________________________________, Employer/Insurer.
WCA No.:__________________
________SUBPOENA OR________SUBPOENA DUCES TECUM TO: _____________________________________ _____________________________________ _____________________________________
GREETINGS: You are commanded to appear, under penalty of law, on ________________________________________ at ______________________________________.m. before the Workers' Compensation Administration at _____________________________________________________________________________________, [Address where adjudication hearing is set] New Mexico, to testify in the above-entitled action on behalf of the ________________________________ [FOR SUBPOENA DUCES TECUM] You are further directed, under penalty of law, to bring the items described with you to the hearing for inspection: ___________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________
WITNESSED & SEALED BY CLERK OF THE WCA (SEAL) By: ___________________________________________ Date: __________________________________________
Worker/Attorney/Representative: Address: City/State/Zip: Telephone:
________________________________ ________________________________ ________________________________ (___)____________________________
11.4.4.9.18.2.J NMAC