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Fill and Sign the Illinois Workers Compensation 497306378 Form

Fill and Sign the Illinois Workers Compensation 497306378 Form

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ILLINOIS WORKERS’ COMPENSATION COMMISSION PETITION TO REINSTATE CASE A TTENTION : This petition must be filed within 60 days of r eceipt of the dismissal order.       Case #       WC       Employee/Petitioner v.             Employer/Respondent On       , this case was dismissed for want of prosecution. I received the dismissal order on       . On       , I will present this petition to reinstate the case before Arbitrator       for the following reason:       __________________________________________ Signature       Name (please print; attorneys, please include IC code #)       Telephone number       Date IC23 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

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