Free IWGuide02 - California


File Size: 150.9 kB
Pages: 1
File Format: PDF
State: California
Category: Workers Compensation
Author: Richard Stephens
Word Count: 92 Words, 971 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.dir.ca.gov/dwc/Dismissalofattorney.pdf

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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)