Reasons for appeal should be substantiated with complete information for an accurate, timely ruling.
Directions are below the form.
Click field description to jump to help. Appeals not received within the specified 10 calendar days will not be eligible for review and all appeal rights forfeited. Appeals may be made in person when a completed form is submitted along with verbal information. Only substantiated, legitimate appeals will be considered. Response will be mailed to the name and address of person listed on Appeal Form.