GERS_Petition_for_Appeal_to_the_Board
PETITION FOR APPEAL TO THE BOARD An appeal is hereby made from the Administrator’s decision in accordance with Rule 715-12 of the Rules and Regulations for Appeals to the Government Employees’ Retirement System’s Board of Trustees. I. Name of Appellant: ________________________________________________ II. Appellant’s Address: _______________________________________________ _______________________________________________ III. Legal Representative (if any): (a) Name: _____________________________________________________ (b) Address: ____________________________________________________ ____________________________________________________ (c) Telephone No: _______________________________________________ IV. State the decision or action below from which an appeal is being taken: (Please attach a copy of the Decision) V. Issues present for review by the Board. VI. Statement of the case: Describe the nature of the case, the course of proceedings and its disposition below: Petition for Appeal to the Board of Trustees VII. …
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PETITION FOR APPEAL TO THE BOARD An appeal is hereby made from the Administrator’s decision in accordance with Rule 715-12 of the Rules and Regulations for Appeals to the Government Employees’ Retirement System’s Board of Trustees. I. Name of Appellant: ________________________________________________ II. Appellant’s Address: _______________________________________________ _______________________________________________ III. Legal Representative (if any): (a) Name: _____________________________________________________ (b) Address: ____________________________________________________ ____________________________________________________ (c) Telephone No: _______________________________________________ IV. State the decision or action below from which an appeal is being taken: (Please attach a copy of the Decision) V. Issues present for review by the Board. VI. Statement of the case: Describe the nature of the case, the course of proceedings and its disposition below: Petition for Appeal to the Board of Trustees VII. Statement of the Facts: Facts which are relevant to the issue presented for review, with appropriate references to the record. VIII. Argument: Set forth Appellant’s contentions with respect to the issues, with citations to the authorities and parts of the record relied on. IX. Statement of the Relief sought: Dated: ______________ ____________________________________ Signature of Appellant