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PETITION TO REVIEW

In the Matter of the Workers' Compensation Claim of: 



Vs




WC #-###-###-##


TO THE DENVER OFFICE OF ADMINISTRATIVE COURTS


The


*No transcript is needed.


Set forth in detail the particular alleged errors and your objections to the order.
Signature
Please type your name in the box below.  By typing your name, you certify this information is accurate and certify that this will act as your binding electronic signature. 











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Certificate of Mailing

I hereby certify that a true and correct copy of this document has been delivered 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 Administrative Courts.  A Petition to Review filed in another office of the OAC will not be accepted for filing.


Office of Administrative Courts

1525 Sherman, 4th Floor

Denver, CO 80203

Opposing Party 1 or their Representative









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Opposing Party 2 or their Representative









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Please type your name in the box below.  By typing your name, you certify this information is accurate and certify that this will act as your binding electronic signature. 


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