Request for Specific Findings of Fact and Conclusions of Law

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In the Matter of the Workers' Compensation Claim of: 



Vs





WC #-###-###-##
A. Request for Specific Findings of Fact and Conclusions of Law
The
is dissatisfied with the Summary Order of the Administrative Law Judge that was served on the parties on:

It is requested that a full order containing specific findings of fact and conclusions of law pursuant to Section 8-43-215, C.R.S. (as amended, SB07-258, Section 7).

B. Signature











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C. Certificate of Mailing

I hereby certify that I mailed or delivered true and correct copies of Request for Specific Findings

of Fact and Conclusion of Law for Transcript to all parties at the addresses shown below.

Claimant/Respondent or their Representative









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Employer or their Representative









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Other









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