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WORKERS’ COMPENSATION APPEALS BOARD

_____ _____ hereby substitutes and _____ _____ _____ _____ _____ STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF WORKERS COMPENSATION WORKERS COMPENSATION APPEALS BOARD Case No. Applicant vs. SUBSTITUTION OF ATTORNEYS Defendant(s) _____ appoints _____ as his attorney in the above entitled case, in the place of _____ who respectively consent hereto.

attorneys. Dated _____. Copies have been served on: (Adverse Parties and Attorneys) (Client) (Former Attorney) (Address and Telephone Number of Attorney) (Present Attorney) (Address and Telephone Number of Attorney) DWC WCAB Form 36 (Rev. 1-99) Title: WORKERS’ COMPENSATION APPEALS BOARD ...

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  Appeal, Board, Attorney, Compensation, Worker, Workers compensation appeals board

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Transcription of WORKERS’ COMPENSATION APPEALS BOARD

1 _____ _____ hereby substitutes and _____ _____ _____ _____ _____ STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS DIVISION OF WORKERS COMPENSATION WORKERS COMPENSATION APPEALS BOARD Case No. Applicant vs. SUBSTITUTION OF ATTORNEYS Defendant(s) _____ appoints _____ as his attorney in the above entitled case, in the place of _____ who respectively consent hereto.

2 A copy has been served on all parties or their attorneys where they have attorneys. Dated _____. Copies have been served on: (Adverse Parties and Attorneys) (Client) (Former attorney ) (Address and Telephone Number of attorney ) (Present attorney ) (Address and Telephone Number of attorney ) DWC WCAB Form 36 (Rev. 1-99)


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