Request For Specific Findings Of Fact And Conclusions Of Law

Revised 3/2015 STATE OF COLORADO OFFICE OF ADMINISTRATIVE COURTS In the Matter of the Workers222 Compensation Claim of: , Claimant, vs. COURT USE ONLY , CASE NUMBER: Employer, and WC , Insurer, Respondents. REQUEST FOR SPECIFIC FINDINGS OF FACT AND CONCLUSIONS OF LAW TO THE OFFICE OF ADMINISTRATIVE COURTS AND ALJ . The ( Claimant/ Employer/ Insurer) is dissatisfied with the Summary Order of the Administrative Law Judge that was served on the parties on (date). It is requested that a full order containing specific findings of fact and conclusions of law issue pursuant to Section 8-43-215, C.R.S. X Signature Attorney Registration Number First Name MI Last Name Suffix E - mail Representing American LegalNet, Inc. www.FormsWorkFlow.com Revised 3/2015 CERTIFICATE OF SERVICE I hereby certify that I mailed or delivered true and correct copies of Request for Specific Findings of Fact and Conclusion of Law t o all parties at the addresses shown below . Opposing Party 1 or their Representative First Name MI Last Name Suffix Company Address City State Zip Phone E - mail Representing Opposing Party 2 or their Representative: First Name MI Last Name Suffix Company Address City State Zip Phone E - mail Representing Signature Date Mailed REV 3 /1 5 American LegalNet, Inc. www.FormsWorkFlow.com