Fill and Sign the Oklahoma Designation Record of Form

Rule 1.301, Form No. 15 IN THE WORKERS' COMPENSATION COURT OF THE STATE OF OKLAHOMA ___________________, ) ) Claimant, ) ) W.C.Ct. No. _______. v. ) ) ____________________, ) ) Respondent, ) ) ____________________ ) Insurance Carrier. ) (If applicable) DESIGNATION OF RECORD FOR REVIEW OF AN ORDER OF THE WORKERS' COMPENSATION COURT Designation of Record Counter-Designation of Record Amended Designation of Record A. DESIGNATION OF RECORD AND TRANSCRIPTS [Claimant or Respondent or Insurance Carrier] _________________ hereby designates the following for inclusion in the record for the Supreme Court's review in this case: B. DATE, SIGNATURE, AND SERVICE BY COUNSEL OR PARTY DATE: _______________, 20 . Signature: __________________________ (Signature of Attorney or Pro Se Party) Attorney for (Claimant, Respondent, or Insurance Carrier) OBA No.: _____________________________ Firm: ________________________________ Address: ______________________________ ______________________________________ ______________________________________ Telephone: _____________________________ CERTIFICATE OF SERVICE I, , hereby certify that in addition to filing the original Designation of Record with the Clerk of the Workers' Compensation Court a copy of the foregoing Designation of Record was mailed by first class mail, postage prepaid, this ___ day of _________ 20__, to the following: [Names and Addresses of all parties or their counsel of record] _______________________________________