MINNESOTA COURT RULES

APPELLATE PROCEDURE

Forms provided here are for reference purposes. To download forms to fill out please visit the Minnesota Courts website.

FORM 116B - WRIT OF CERTIORARI

STATE OF MINNESOTA

IN SUPREME COURT

CASE TITLE:
	WRIT OF CERTIORARI
Employee-
Relator,	SUPREME COURT NUMBER:
	WORKERS' COMPENSATION
	COURT OF APPEALS
vs.	NUMBER:
	DATE OF SERVICE OF
Employer-	WRITTEN NOTICE OF
Respondent,	DECISION:
Insurer-
Respondent.

TO:	The Workers' Compensation Court of Appeals:

You are hereby ordered to return to the Supreme Court within 30 days from this date the record, exhibits and proceedings in the above-entitled matter so that this court may review the decision of the Workers' Compensation Court of Appeals.

Copies of this writ and accompanying petition shall be served forthwith either personally or by mail upon the Secretary of the Workers' Compensation Court of Appeals and upon the Employer-Respondent(s) above-named or their attorney(s) at:

_

_

(address)

Proof of service shall be filed with the clerk of the appellate courts.

DATED:

Clerk of Appellate Courts

(Clerk's File Stamp)

By: _

Assistant Clerk

(Amended effective for appeals taken on or after January 1, 1992.)