Workers' Compensation Board State of Oregon
In the Matter of the Request for Hearing of ) WCB Case No. ) ) SUBPOENA ) To Compel Attendance and ) Testimony at Hearing
To:
YOU ARE DIRECTED to appear before the Workers' Compensation Board of the State of Oregon to testify in the above case. Place of Appearance: Time of Appearance:
Date of Appearance:
[Complete this section only if applicable] YOU ARE DIRECTED to produce and permit inspection of the following documents or objects at the place, time and date listed above:
Date
Issuer
PROOF OF SERVICE
Person Served (print name) Place of Service Server Signature of Server NOTE: ORS 656.732, 654.130 and 183.445 provide, in applicable cases, that the Circuit Court of any county shall compel obedience to subpoenas issued and served and to punish disobedience or any refusal to testify or answer any lawful inquiry. Date of Service Manner of Service (in person or certified mail) Title of Server (print)