Free lb0897AppealsNewAddress.pmd - Tennessee

STATE OF TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT Division of Employment Security Appeals Operations 220 French Landing Drive Nashville, Tennessee 37243
Telephone: (615) 741-1857 Facsimile: (615) 741-8933

Notice of Appeal

Claimant's Social Security Number ________________________

Claimant's Name ___________________________________

Employer's Name _________________________________

Street Address _____________________________________

Street Address ___________________________________

City ______________________ State ____ Zip __________

City ____________________ State ____ Zip ___________

Claimant's Telephone _______________________________

Employer's Telephone _____________________________

I am the:

claimant

employer.

I am appealing the: Agency decision dated ________________________________ to the Appeals Tribunal. Appeals Tribunal decision dated _________________________ to the Board of Review.

I believe the decision was incorrect because _______________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

I request a hearing:

in person

by telephone

Date________________________

Signature___________________________________ Title________________________________________ (if employer)

LB-0897