Fillable ILLINOIS WORKERS COMPENSATION COMMISSION PROOF OF SERVICE (Illinois)

Fill Online, Printable, Fillable, Blank ILLINOIS WORKERS COMPENSATION COMMISSION PROOF OF SERVICE (Illinois) Form

Use Fill to complete blank online ILLINOIS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

ILLINOIS WORKERS COMPENSATION COMMISSION PROOF OF SERVICE (Illinois)

On average this form takes 2 minutes to complete

The ILLINOIS WORKERS COMPENSATION COMMISSION PROOF OF SERVICE (Illinois) form is 1 page long and contains:

  • 0 signatures
  • 3 check-boxes
  • 5 other fields

Country of origin: US
File type: PDF

BROWSE ILLINOIS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
ILLINOIS WORKERS’ COMPENSATION COMMISSION
PROOF OF SERVICE
ATTENTION. If the person who signed the Proof of Service is not an attorney, this form must be notarized.
Service for documents related to Section 19(b-1) of the Workers' Compensation Act must be made by personal service or certified mail.
I, ___________________________________________________ , affirm that I
_____ mailed a copy of this form with proper postage in the city of __________________
_____ sent a copy of this form by certified mail (return receipt requested)
_____ delivered a copy of this form
at _____________ on _____________________ to each party at the address listed below.
__________________________________________________
Signature of person completing Proof of Service
Signed and sworn to before me _____________________
_________________________________________________
Notary Public
IC15 12/04 100 W. Randolph Street #8-200 Chicago, IL 60601 312/814-6611 Toll-free 866/352-3033 Web site: www.iwcc.il.gov
Downstate offices: Collinsville 618/346-3450 Peoria 309/671-3019 Rockford 815/987-7292 Springfield 217/785-7084
AM
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

ILLINOIS WORKERS COMPENSATION COMMISSION PROOF OF SERVICE (Illinois)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 May 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document