Colorado > Workers Comp

Petition To Review - Colorado

Petition To Review Form. This is a Colorado form and can be used in Workers Comp .
 Fillable pdf Last Modified 8/4/2011
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STATE OF COLORADO OFFICE OF ADMINISTRATIVE COURTS 633 17th Street, Suite 1300 Denver, Colorado 80202 In the Matter of the Workers' Compensation Claim of: Claimant, vs. Employer, and Insurer, Respondents. È COURT USE ONLY È CASE NUMBER: PETITION TO REVIEW TO THE DENVER OFFICE OF ADMINISTRATIVE COURTS: s The ( claimant/ employer/ insurance carrier) petitions to review the order of the Administrative Law Judge (ALJ) mailed or served on _________________ (date). No transcript is requested. Petitioner objects to the Findings of Fact, Conclusions of Law, and Order of the ALJ on the following ground(s): (Set forth in detail the particular alleged errors and your objections to the order. You may attach additional pages): Revised 7/15/09 American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I hereby certify that a copy of this document has been mailed to the ALJ and to the following parties, at the addresses shown and on the date below: (This Petition to Review must be filed with the Denver Office of Admiistrative Courts. A Petition to Review filed in another office of the OAC will not be accepted for filing.) Opposing Party or Attorney: Office of Administrative Courts 633 17th Street, Suite 1300 Denver, CO 80202 Mailed on the ______ day of ____________________, 20____. Signature of Petitioner or Attorney Petitioner's Name and Address (Printed) Revised 7/15/09 American LegalNet, Inc. www.FormsWorkFlow.com
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