(DATE)
Director
Department of Agriculture
State Fairgrounds
Springfield, Illinois 62706
PETITION
The undersigned submits this petition pursuant to (relevant statutory reference, if known) to request the Director of Agriculture to (amend, issue, or revoke a regulation or take or refrain from taking any other form of administrative action).
(A full statement of the factual and legal grounds upon which the petitioner relies. Such grounds shall include all relevant data, information and views on which the petitioner relies and fiscal implications, if applicable.)
The undersigned certifies that, to the best of such person's knowledge and belief this petition includes all data, information and views on which the petition relies, and that it includes representative data and information known to the petitioner which are unfavorable to the petition.
Very truly yours,
(Signature)
(Complete Mailing Address)
(Telephone number)
Ill. Admin. Code tit. 8, pt. 1, subpt. E, ILLUSTRATION A