Standard Affidavit Form

Document Number:  UCL-17500-E

Description:  This form is provided to parties to UI appeal hearings for their use per statutory requirement.

Comments:  Information on how to complete the form and where to send it is included in the second page of the form.

Content Contact:  UI BOLA

Document Attachment:  UCL-17500-E (pdf/143 KB)

NOTE:  When using Google Chrome, you may notice overlapping text when you select file, print.  Deselect the 'fit to page' option and the text will no longer overlap.

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

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