Fillable CASE NO. (FLRA)

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CASE NO. (FLRA)

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CASE NO.
Fill out the information in the boxes in sections 1 and 2 below
Section 1 – Party
Section 2 - Representative Information
Name
Telephone No.
Title
Cell No.
Address
City State ZIP
Fax No.
E-mail
The person named above represents the party named in Section 1 in this case. Please serve this
representative with all written communications, except for subpoenas. This designation remains
effective until it is revoked or a new designation is filed.
Name (please print or type)
Signature
Charged Party
and
Charging Party
FLRA Form 75
(Rev. 12/2013)
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CASE NO. (FLRA)

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Completed 19 July 2020

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