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.
*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page. Links to each specific vendor's site have been provided for you. Thank you.