Workers' Compensation Board State of Oregon
In the Matter of the Request for Hearing of ) WCB Case No. ) ) SUBPOENA ) To Compel the Production of Documents ) or Objects other than Individually ) Identifiable Health Information
To:
YOU ARE DIRECTED to appear and produce and permit inspection of the following documents or objects at the place, time and date listed below: To be produced:
Place of Production:
Time of Production:
Date of Production:
IN LIEU OF APPEARANCE, you may comply with this subpoena by delivering or mailing copies of the above documents or objects to the party issuing this subpoena at the following address.
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)