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Worker Compensation Trial Subpoena

Worker Compensation Trial Subpoena Request Form
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NOTE
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Commonwealth of Massachusetts

 

Please ask for Attorney (Enter the Attorneys name)
(Enter the Attorneys phone number)

, s.s.
DIA # (Enter the DIA Number)

To: (Enter Name and Address Information In the fields below)
(Name)
(Address line 1)
(Address Line 2 if any)
(City, State Zip)


Greetings:


YOU ARE HEREBY COMMANDED in the name of the Commonwealth of Massachusetts to appear before the Department of Industrial Accidents, holden at within and for the county of  (Enter the County) on the day of , at (Enter the Time) in the and from day to day thereafter,until the action hereinafeter named is heard by said court, to give evidence of what you know relating to an action of Workers Compensation then and there to be heard and tried between...


Employee ,and
Employer ,and


You are further required to bring with you :


Check here if person does not need to appear but should send records.


***If the above requested documents are produced to Attorney at on or before (Enter the Deadline Date) there will be no need to appear at the Department of Industrial Accidents on ***


Hereof fail not as you will answer your default under the pains and penalties in the law in that behalf made and provided.


Dated at Cambridge the day of A.D .

                                      

 

                                             
_________________________________
Notary Public
My Commission expires February 25, 2022