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STATE OF CALIFORNIA
Department of Industrial Relations
Division of Workers' Compensation
WORKERS' COMPENSATION APPEALS BOARD
) ) ) Applicant, ) ) ) ) ) ) )
Case No.
vs.
Notice of Dismissal of Attorney
Defendants
I,________________________________________________________, applicant in the above-entitled case, have heretofore been represented by ___________________________________________________ as my attorney of record. I have dismissed said attorney and have no attorney whatsoever at the present time and wish to have future documents served upon me and not on my former attorney.
Copies of this notice were mailed to the following: ___________________________________ ___________________________________ ___________________________________ ___________________________________ on _________________________________
(Date )
______________________________
(Applicant)
______________________________
(Address)
DWC/WCAB FORM 37 (REV. 8-75)