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
Request to Withdraw Appeal
Claimant's Social Security Number ____________________________
Docket 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.
Please withdraw my appeal. I do not wish to pursue this appeal further because ___________________________________
_________________________________________________________________________________________________________ (optional) _________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Date _______________________
Signature ______________________________________ Title ___________________________________________ (if employer)
LB-0894