Free Petition for Appointment of Gua - California


File Size: 310.7 kB
Pages: 1
Date: July 18, 2006
File Format: PDF
State: California
Category: Workers Compensation
Author: thanf
Word Count: 182 Words, 1,190 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.dir.ca.gov/dwc/forms/DWCForm8.pdf

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STATE OF CALIFORNIA

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DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF WORKERS' COMPENSATION

WORKERS' COMPENSATION APPEALS BOARD
Case No.

Applicant
VS.

Petition for Appointment of Guardian ad Litem and Trustee
Defendants

As a result of an alleged industrial injury on to
Injured Employee

, while employed by benefits are claimed by
Employer

the following minor(s)/incompetent(s):
Strike inapplicable matter

Name

Date of Birth

The minor(s)/incompetent(s) require a Guardian ad Litem and Trustee to prosecute the claim and to receive
Strike inapplicable matter

and receipt for any benefits awarded or voluntarily furnished. The Workers' Compensation Appeals Board is requested to appoint , as Guardian ad Litem and Trustee. * who has legal custody of, and is legally responsible for the support of the minor(s).
( * Strike if not applicable.) We hereby join in the above request. Relationship if any

,

Date

,

Petitioner Address

NOTE: Consent must be signed by all minors over 14 years of age and by all adults with sufficient capacity to form an intelligent preference.

Attorney for Petitioner

Address and telephone number
DIA WCAB FORM 8 (REV. 10-90) WCAB-8