Brief Adjudicative Proceeding Timeliness Declaration

Claimant Information
Claimant Name
Address
Timeliness Declaration
I am the (check one)

Please answer all of the following questions. Some of the questions may have been asked during the Employment Security Department’s investigation.  Please answer the questions here, even if you answered the same questions before.

1. Did you receive the Determination Letter under appeal?
4. Did you read and understand the Determination Letter under appeal?

I declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form are true.