Free REQUEST TO STRIKE APP OF COUNSE.PDF - Maryland


File Size: 180.0 kB
Pages: 1
File Format: PDF
State: Maryland
Category: Workers Compensation
Author: james
Word Count: 145 Words, 961 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.wcc.state.md.us/PDF/PDF_Forms/eReqStrike.pdf

Download REQUEST TO STRIKE APP OF COUNSE.PDF ( 180.0 kB)


Preview REQUEST TO STRIKE APP OF COUNSE.PDF
WORKERS' COMPENSATION COMMISSION

REQUEST TO STRIKE APPEARANCE OF COUNSEL
WCC Claim Number: Claimant Social Security No.: Date of Accident: Claimant: Insurer/Self-Insurer: Employer:

The Counsel listed below, who currently represents the following party in the abovereferenced claim, requests that said attorney's appearance be stricken from this case:
Claimant Employer/Insurer SIF UEF Healthcare Provider

ATTORNEY INFORMATION: (Complete in Adobe Reader, type or print only) Name of Counsel: WCC Attorney Registration No: Street Address: City/State/Zip: Telephone:

I hereby certify that on this day of , 20 a copy of this Request to Strike Appearance of Counsel was mailed to all parties and/or their attorneys.

,

___________________________________
Signature

CLICK HERE TO CLEAR THE FORM
WCC Form C25R (Rev 08/28/03)

10 East Baltimore Street Baltimore, Maryland 21202-1641 410-864-5100 Email: [email protected] Web: http://www.wcc.state.state.md.us