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Fill and Sign the Illinois Workers Compensation 497306380 Form

Fill and Sign the Illinois Workers Compensation 497306380 Form

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Select the illinois workers compensation case lookup and open it.
Fill out the form and add an eSignature.
Save the illinois workers comp case lookup, print, or email it.

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ILLINOIS WORKERS’ COMPENSATION COMMISSION MOTION TO WITHDRAW AS ATTORNEY OF RECORD       Case #       WC       Employee/Petitioner v.             Employer/Respondent I,       , attorney for the petitioner respondent , request permission to withdraw as the attorney of record on this case for the following reason:       ________________________________________ Signature of attorney       Name of attorney and IC code # (please print)       Date IC28 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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