Last Update: 1/14/2016 (Transmittal I-2-160)
HA 01260.095 Exhibit – Recording
Storage Envelope
Renumbered from HALLEX section I-2-6-95
FRONT OF RECORDING STORAGE ENVELOPE
Claimant's Name __________________ Claim Number __________________
Date and Time __________________ City _____________________________
ALJ __________________________ H _______________________________
Claimant Represented by ___________________________________________
Witnesses _________________________, _____________________________
Recording No._____ of _____