12-1573 ORDER TO DISMISS - dphhs mt-2026

1. Click ‘Get Form’ to open the 12-1573 ORDER TO DISMISS in the editor.
2. Begin by entering the Claimant's name in the designated field at the top of the form. Ensure that this information is accurate as it identifies the individual involved in the case.
3. Next, review the case number section. Confirm that 'Case No. 12-1573' is correctly displayed, as this is crucial for tracking and referencing your appeal.
4. In the response section, if applicable, indicate whether you wish to withdraw your appeal or proceed further. This decision must be made clearly to avoid any confusion.
5. Finally, complete the Certificate of Service section by filling in the date you are mailing this document and ensuring all necessary parties are listed correctly for notification purposes.

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