Form WC-25-A Subpoena Duces Tecum - Missouri

Form WC-25-A is a Missouri Department of Labor and Industrial Relations form also known as the "Subpoena Duces Tecum". The latest edition of the form was released in April 1, 2012 and is available for digital filing.

Download an up-to-date Form WC-25-A in PDF-format down below or look it up on the Missouri Department of Labor and Industrial Relations Forms website.

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MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
INJURY NUMBER
3315 West Truman Blvd., P.O. Box 58
Jefferson City, MO 65102-0058
SUBPOENA DUCES TECUM
-
+
THE STATE OF MISSOURI,
To
You are hereby commanded to be and appear personally before the Division of Workers’ Compensation, Department
of Labor and Industrial Relations, at the hour of
M., on
,
at
in
, Missouri, to testify on the hearing of a Claim
for Compensation under the Missouri Workers’ Compensation Law between
, employee (or dependent),
, employer, and
, insurer,
in behalf of the
,
and you are further commanded to bring with you, and then and there produce in evidence
,
and hereof fail not at your peril.
Given by order of the Division of Workers’ Compensation, Department of Labor and Industrial Relations, with the
seal of the Division of Workers’ Compensation of the Department of Labor and Industrial Relations of the State of
Missouri affixed, at the City of
, Missouri, this
day of
.
DIVISION OF WORKERS’ COMPENSATION
(SEAL)
By
Director/Administrative Law Judge
(Over)
+
WC-25-A
WC-25-A (04-12) AI
MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
INJURY NUMBER
3315 West Truman Blvd., P.O. Box 58
Jefferson City, MO 65102-0058
SUBPOENA DUCES TECUM
-
+
THE STATE OF MISSOURI,
To
You are hereby commanded to be and appear personally before the Division of Workers’ Compensation, Department
of Labor and Industrial Relations, at the hour of
M., on
,
at
in
, Missouri, to testify on the hearing of a Claim
for Compensation under the Missouri Workers’ Compensation Law between
, employee (or dependent),
, employer, and
, insurer,
in behalf of the
,
and you are further commanded to bring with you, and then and there produce in evidence
,
and hereof fail not at your peril.
Given by order of the Division of Workers’ Compensation, Department of Labor and Industrial Relations, with the
seal of the Division of Workers’ Compensation of the Department of Labor and Industrial Relations of the State of
Missouri affixed, at the City of
, Missouri, this
day of
.
DIVISION OF WORKERS’ COMPENSATION
(SEAL)
By
Director/Administrative Law Judge
(Over)
+
WC-25-A
WC-25-A (04-12) AI
RETURN
STATE OF MISSOURI
ss.
of
being duly sworn, on his oath states that he served the within subpoena in the City of
Missouri, on the
day of
, by delivering a true copy
thereof to the within named
Subscribed and sworn to before me, this
day of
My term expires
Notary Public
WC-25-A-2 (04-12) AI

Download Form WC-25-A Subpoena Duces Tecum - Missouri

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