NOTICE OF WITHDRAWAL OF APPEAL

 

Appellant Name _______________________________ Appeal No. ____________________

Presiding Officer _______________________________ Date ________________________

 

TO OFFICE OF ADMINISTRATIVE HEARINGS:

I, _________________________________________________________, residing at
(Appellant/Representative)

____________________________________________________________________________________,
(Address)

hereby wish to inform you that I am withdrawing my appeal to the Office of Administrative

Hearings which was made on __________________________ for the following reasons:
                                                       (Date)

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

I am taking this action voluntarily.

 

_________________________________________
(Signature of Applicant)

 

***PLEASE RETURN THIS FORM TO:

Office of Administrative Hearings
1020 S Kansas Avenue
Topeka, Kansas 66612-1327

 

 

Office of Administrative Hearings