STATE OF CALIFORNIA
Department of Industrial Relations
Division of Workers' Compensation
WORKERS' COMPENSATION APPEALS BOARD
Applicant,
vs.
Defendants
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Case No.
Notice of
Dismissal of Attorney
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)
