5 Oklahoma City, OK 73152 To be completed by the local office Case name Case number Office name and number Date withdrawal requested I. WITHDRAWAL After discussing my situation with I wish to withdraw my request for a hearing before the Oklahoma Department of Human Services. I am withdrawing my request for the following reasons: II. SIGNATURE A. If the withdrawal of the hearing request is made by the client, this item is completed. Client s signature Date Witness if signed by mark: Sig.
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How to fill out the OK 13MP004E (H-3) online
The OK 13MP004E (H-3) form is used for withdrawing a request for a hearing before the Oklahoma Department of Human Services. This guide will provide clear, step-by-step instructions for completing this form online, ensuring users can navigate the process easily and effectively.
Follow the steps to fill out the OK 13MP004E (H-3) online.
- Locate and click the ‘Get Form’ button to access the OK 13MP004E (H-3) form online. This will allow you to open the form in an editable format.
- Fill in the 'case name' and 'case number' fields. This information is crucial to identify your specific request.
- Enter the 'office name and number' where your case is managed. This helps ensure that your withdrawal is processed through the correct local office.
- Provide the 'date withdrawal requested'. Be sure to enter the date you are submitting this withdrawal.
- In section I, clearly state your desire to withdraw your request for a hearing. After discussing your situation, explain the reasons for your withdrawal.
- In section II, if you are the client making the request, please provide your signature and the date of your signature.
- If applicable, if the withdrawal is made by someone acting on behalf of the client, fill in the client’s name and the signature of the person making the request.
- If the request has been signed by mark, make sure to have two witnesses sign. Include their signatures, addresses, city, state, and zip code.
- After completing all necessary sections, you can save your changes, download the completed form, print it, or share it as needed.
Complete your document online today for a smooth withdrawal process.
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