Form LB-0894 "Request to Withdraw Appeal" - Tennessee

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STATE OF TENNESSEE
DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT
Division of Employment Security
Appeals Operations
220 French Landing Drive
Nashville, Tennessee 37243-1002
Telephone: (615) 741-1857
Facsimile: (615) 741-8933
REQUEST TO WITHDRAW APPEAL
Claimant’s Social Security Number ______________________
Docket Number _____________________
Claimant’s Name _____________________________________
Employer’s Name ______________________________________
Street Address ______________________________________
Street Address _______________________________________
City _____________________ State ____ Zip ______________
City ______________________ State ____ Zip ______________
Claimant’s Telephone ______________________________
Employer’s Telephone ________________________________
I am the:
claimant
employer
Please withdraw my appeal.
(optional) I do not wish to pursue this appeal further because
Date ___________________
Signature _________________________________________
Title (if employer) __________________________________________________
LB-0894 (Rev. 04-11)
RDA 1643
STATE OF TENNESSEE
DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT
Division of Employment Security
Appeals Operations
220 French Landing Drive
Nashville, Tennessee 37243-1002
Telephone: (615) 741-1857
Facsimile: (615) 741-8933
REQUEST TO WITHDRAW APPEAL
Claimant’s Social Security Number ______________________
Docket Number _____________________
Claimant’s Name _____________________________________
Employer’s Name ______________________________________
Street Address ______________________________________
Street Address _______________________________________
City _____________________ State ____ Zip ______________
City ______________________ State ____ Zip ______________
Claimant’s Telephone ______________________________
Employer’s Telephone ________________________________
I am the:
claimant
employer
Please withdraw my appeal.
(optional) I do not wish to pursue this appeal further because
Date ___________________
Signature _________________________________________
Title (if employer) __________________________________________________
LB-0894 (Rev. 04-11)
RDA 1643
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Download Form LB-0894 "Request to Withdraw Appeal" - Tennessee

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