| 1 JDF 662 - Certificate of Service (ICAO) Last Revised: , 2017 Certificate of Service I certify that on (date) , I { mailed}, or { hand delivered} (title of document served) to the Court of Appeals and mailed copies to the people listed below: (You must send a copy to each party. If a party has a lawyer, send the copy to the lawyer) Industrial Claim Appeals Office 633 17th St., Suite 00 Denver, CO 80202-3660 Colorado Attorney General 1300 Broadway, 6th Floor Denver, Colorado 80203 Other Parties (For example, the employer if you are the claimant, or claimant if you are the employer): Name of Person Served: Street Address: City: State: Zip: Space for other parties served: Signature: Print Name: American LegalNet, Inc. www.FormsWorkFlow.com