ࡱ> { Ubjbjzz 7: (((((-.@@@@0K4U,W,W,W,W,W,W,$L.0~{,]{,@@,### @@U,#U,##r'(@`L:v (A,,0-(|1 R|1(|1(D"=#Ui{,{,e#:-|1 : State of New Jersey Department of Labor and Workforce Development DIVISION OF WORKERS COMPENSATION WC-100-Dismissal Interactive (r. 7/1/2013)ORDER FOR DISMISSAL CASE NO S.:  FORMTEXT       VICINAGE:  FORMDROPDOWN  PETITIONERNAME:  FORMTEXT       ATTORNEY FOR PETITIONERFEDERAL EMPLOYER NUMBER:  FORMTEXT      DATE OF BIRTH:  FORMTEXT       NAME:  FORMTEXT      ADDRESS:  FORMTEXT       ADDRESS:  FORMTEXT        RESPONDENTvsTELEPHONE NUMBER (AREA CODE):  FORMTEXT      NAME:  FORMTEXT      APPEARING:  FORMTEXT      ADDRESS:  FORMTEXT        INSURANCE CARRIERNAME  FORMCHECKBOX  SELF-INSURED  FORMCHECKBOX  TPA  FORMTEXT      ADDRESS:  FORMTEXT      ATTORNEY FOR RESPONDENTNAME:  FORMTEXT      ADDRESS:  FORMTEXT      CLAIM NUMBER:  FORMTEXT      TELEPHONE NUMBER (AREA CODE):  FORMTEXT       APPEARING:  FORMTEXT       THIS MATTER HAVING COME BEFORE THE COURT ON THIS FORMTEXT      DAY OF  FORMDROPDOWN , FORMDROPDOWN   FORMCHECKBOX  ORDER FOR DISMISSAL WITHOUT PREJUDICE  FORMCHECKBOX  Lack of Prosecution pursuant to NJSA 34:15-54, subject to the right to apply to the Division of Workers' Compensation to have the petition reinstated for good cause, within one year from the date of this dismissal.  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ALLOWEDPAYABLE BY PETITIONERPAYABLE BY RESPONDENT FORMTEXT        FORMDROPDOWN   FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT        FORMDROPDOWN   FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      STENOGRAPHIC SERVICE:  FORMDROPDOWN   FORMTEXT       FORMDROPDOWN   FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       WE HEREBY CONSENT TO THE ENTRY AND FORM OF THIS ORDER AND ACKNOWLEDGE RECEIPT OF COPY: PETITIONER S ATTORNEY JUDGE OF COMPENSATION DATE  FORMTEXT      PETITIONER (where applicable) JUDGE S NAME THE ORIGINAL OF THIS DOCUMENT, SIGNED BY THE JUDGE OF COMPENSATION, WILL BE MAINTAINED ON FILE IN THE DIVISION OF WORKERS COMPENSATION, PURSUANT TO N.J.S.A. 34:15-121 et seq. 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