Neb. Admin. Code GAME AND PARKS COMMISSION, tit. 163, ch. 1, app A
BEFORE THE GAME AND PARKS COMMISSION, STATE OF NEBRASKA
In the matter of)
the application of [name]) PETITION FOR
___________________) DECLARATORY ORDER
1. Petitioner's name and address;
2 . The name and address of all persons who or entities which may have a specific interest in the applicability of the statute, rule, regulation, or order, or who may be adversely affected by the issue sought to be resolved;
3. All material facts and specific circumstances;
4. All rules of law which apply;
5. Petitioner's demand for relief;
DATED on this ______ day of _____________, 2______.
VERIFICATION
STATE OF ________________)
) ss.
COUNTY OF ______________)
[name]______________, being first duly sworn, states that he/she is the petitioner/petitioner's agent in the above entitled matter; that he/she has read the foregoing Petition For Declaratory Order; and that the allegations of fact therein are true.
_______________________
[Petitioner's signature]
SUBSCRIBED and sworn to before me on this _______ day of __________, 2 _______.
NOTARY SEAL
[Notary signature]
Neb. Admin. Code GAME AND PARKS COMMISSION, tit. 163, ch. 1, app A