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Ariz. R.P. Spec. Actions Form 4
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Form 4 Caption for Industrial Commission of Arizona Special Action
Appendix Forms of Caption
Rule Text
Attorney or Party Name
ARIZONA COURT OF APPEALS
WORKER NAME,
)
Court of Appeals
)
Division [One or Two]
Petitioner,
)
No. 1 CA-IC___-______
)
v.
)
ICA Claim
)
No. _____-__________
THE INDUSTRIAL COMMISSION
)
OF ARIZONA,
)
Carrier Claim [if applicable]
)
No.______-______-WC-___
Respondent,
)
)
COMPANY NAME,
)
)
Respondent Employer,
)
PETITION FOR SPECIAL ACTION
)
- INDUSTRIAL COMMISSION
INSURANCE COMPANY NAME,
)
[if applicable]
)
)
Respondent Carrier.
)
)
)
Amendment history: Added Aug. 22, 2024, effective Jan. 1, 2025.