Unemployment Insurance Appeal - Request/Motion to Reinstate Hearing (Withdrawn Appeal)

Date of Request

Docket Number(s)

Appellant Name

First Name

Last Name

Business Name (optional)

Address

Street Address

City

State

Postal Code

Phone Number

Explain your good cause reason to reinstate your hearing (withdrawn appeal)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.