To: (Enter Name and Address Information
In the fields below) (Name) (Address line 1) (Address Line 2 if any) (City, State Zip)
Greetings:
YOU ARE HEREBY COMMANDED in the name of the Commonwealth of
Massachusetts to appear before the Department of Industrial Accidents,olden at
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at (Enter the Time)
forenoon
afternoon
and from day to day thereafter,until the action hereinafeter named is
heard by said court, to give evidence of what you know relating to an
action of Workers Compensation then and there to be heard and
tried between...
Employee ,and
You are further required to bring with you :
Check here if person does not need to appear but should send records.
***If the above requested documents are produced to Attorney(Enter the Deadline Date)
Hereof fail not as you will answer your default under the pains and
penalties in the law in that behalf made and provided.
Dated at Cambridge the
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.
