Fillable Printable De9403

De9403

DE 9403 Rev. 1 (2-04) (INTERNET) Page 1 of 1 CU

Conditional Withdrawal

I, , hereby withdraw my request for a

hearing to protest the Earning Withholding Order for Taxes of the Employment

Development Department (EDD). That request was dated .

I ask that my case be treated as an administrative complaint which may be resolved

informally without hearing. I understand that if I do not agree with the administrative

resolution, I may file a new request for a hearing.

Date Signature