Petition For Review Of Findings Of Fact And Conclusions Of Law
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Petition For Review Of Findings Of Fact And Conclusions Of Law Form. This is a Colorado form and can be use in Workers Comp.
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Tags: Petition For Review Of Findings Of Fact And Conclusions Of Law, Colorado Workers Comp,
STATE OF COLORADO
DIVISION OF ADMINISTRATIVE HEARINGS
1120 Lincoln St.14th Floor, Denver, Colorado 80203
PETITION FOR REVIEW OF FINDINGS OF FACT AND CONCLUSIONS OF LAW
, Claimant
W.C.#
, Employer
, Insurance Carrier
TO THE DIVISION OF ADMINISTRATIVE HEARINGS AND ALJ :
The (claimant/employer/insurance carrier) petitions for review the order of the
Administrative Law Judge issued on (mo/day/yr)
.
Petitioner objects to the following specific findings/decisions of the Administrative Law
Judge for the reasons stated:
The undersigned wishes to order and pay for the following transcript(s) as part of this
Petition to Review:
Date of Hearing
Court Reporter
_______________________________
_______________________________
_______________________________
_______________________________
I hereby certify that a copy of this document has been mailed to the ALJ and to the
following parties, at the addresses shown, on the date below:
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
Signature of Petitioner or Attorney
_______________________________
Petitioner's Name - Printed
_______________________________
Address of Petitioner or Attorney
Mailed on this _____ day of _____________ , 20 ___ .
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