Form No. 9 - Petition For Review - Supreme Court Of The State Of Oklahoma
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3Rule 1.301, Form No. 9
IN THE SUPREME COURT OF THE STATE OF OKLAHOMA
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,
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Petitioner,
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v.
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No.
,and
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THE WORKERS' COMPENSATION
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COURT,
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Respondents.
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PETITION FOR REVIEW
A. WORKERS' COMPENSATION COURT HISTORY
Number and style of proceeding in the court: ___________________________________
Decision to be reviewed was rendered by: (Check one)
(
) The Workers' Compensation Court en banc, or
(
) A Judge of the Court.
Date of filing of the decision to be reviewed? ____________________
Date a copy of the decision was sent to the parties? ____________________
If seeking a review of the decision of the court en banc, also give date of the decision by the trial
judge: ____________________, and the date an appeal was brought to the tribunal en banc:
____________________ (Otherwise mark N/A).
B. DISPOSITION IN THE WORKERS' COMPENSATION COURT
Nature of the decision to be reviewed ____________________________________
Relief sought: ______________________________________________________
Relief granted: _____________________________________________________
(Attach a certified copy of the decision to be reviewed as exhibit "A".)
A copy of the clerk's certificate that the employer has an approved statutory bond on file with the
court also is attached hereto ____ Yes ____ No
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