Request for Hearing
Date: _______________________
To: Pat Hill
Case Management Supervisor
From: ________________________
PLEASE GIVE THE FOLLOWING INFORMATION. THE CASE CANNOT BE SET PENDING RECEIPT. YOUR TRANSMITTAL FORM WILL BE RETURNED IF NOT COMPLETED.
1) Caption: (please indicate in the exact form how the caption should read. DO NOT FORGET THE DOCKET NUMBER. IT MUST CONFORM WITH OAH PROCEDURES):
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) No: - -
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)
)
)
____________________________________________________________________
2) Check one: _____ contested case (agency action not taken, pending hearing)
_____ appealable agency action (appeal from agency action)
3) Date regulated party requested hearing _____________________________.
4) Requested date and time of hearing ________________________________.
5) Approximate predicted length of hearing: ___________________________.
6) Approximate number of witnesses, if known: ________________________.
______________________________________________________________________________
FOR USE BY OAH ONLY: Assigned ALJ: ________________________________________
Assigned Date , Time and Location: _______________________
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Office of Administrative Hearings
1400 West Washington, Suite 101 - Phoenix, Arizona 85007
Telephone (602)-542-9826 FAX (602)-542-9827
Jane Dee Hull Cliff Vanell
Governor Director
Mission Statement
The Office of Administrative Hearings will contribute to the quality of life in the State of Arizona by fairly and impartially hearing the contested matters of our fellow citizens arising out of State regulation.