Colorado Department of Personnel & Administration Office of Administrative Courts www.colorado.gov/ oac Hearing Cancellation Today222s Date: Case No: Case Name: Date of Hearing: Time of Hearing: Location of Hearing: Attorney or Pro Se Party requesting cancellation Person submitting the request First Name Last Name Email Address: I am the: Check here to certify that you have conferred with the opposing party and that they agree to cancel this hearing Reason for Cancellation: Issue(s) Resolved Case Settled Application /Appeal Withdrawn I hereby certify that I mailed or delivered true and correct copies of the Hearing Cancellation t o all parties at the addresses shown below: (A claimant must provide a copy to the employer and the insurer, or their attorney.) : Party 1 First Name MI Last Name Suffix Company Address City State Zip Phone E - mail Recipient is the: Party 2 First Name MI Last Name Suffix Company Address City State Zip Phone E - mail Recipient is the: Signature of person submitting document Date served Rev 3 /15 American LegalNet, Inc. www.FormsWorkFlow.com