Ariz. R. P. Jud. Rev. Admin. Decision. Form 1
A.R.S. §§ 12-901(2), 12-904, 12-906, 12-909(A), | ||
12-914, JRAD Rule 4 | ||
Distribution: | ||
Clerk of Superior Court--Original | ||
Each Appellee--1 (served as provided | ||
in Rule 4, Ariz. R. Civ. P.) | ||
Time to File: Within 35 days from the date when a | ||
copy of the final administrative decision, as defined | ||
in A.R.S. § 12-901(2), sought to be reviewed is | ||
served upon the party affected. | ||
Attorney or Party Name | ||
State Bar No. (if any) | ||
Law Firm Name (if any) | ||
Complete Mailing Address | ||
Telephone Number | ||
Email Address | ||
Attorney for __________ (party name) | ||
SUPERIOR COURT OF ARIZONA
____________________ COUNTY
_______________ | ) | ||||
Appellant(s), | ) | Case No. __________ | |||
) | |||||
vs. | ) | NOTICE OF APPEAL FOR | |||
_________ | ) | JUDICIAL REVIEW OF | |||
) | ADMINISTRATIVE DECISION | ||||
Appellee(s). | ) | (Administrative Review) | |||
) | |||||
Pursuant to A.R.S. § 12-904, [name of Appellant(s)] appeals from the final administrative decision [name of final decision] issued by [name of agency] on [date] in cause no. __________ [agency docket number or case number].
Pursuant to JRAD Rule 4, the following items are included in this Notice of Appeal:
1. The caption of the case and the administrative agency case number are _______________.
2. The party or parties filing the appeal are as follows: _______________.
3. The final administrative decision from which the party is appealing is _______________, which was issued on _______________.
4. The findings and decision or part of the findings and decision sought to be reviewed is as follows _______________.
5. The issues presented for review are as follows:
.
6. A request for trial de novo, is/is not requested.
[Appellant requests an award of attorney's fees incurred pursuant to (specify substantive authority that authorizes the fee award).]
DATED this day of ______________________________, 20 _____
Signature of Attorney or
Self-Represented Party
The following parties appeared before the agency:
Ariz. R. P. Jud. Rev. Admin. Decision. Form 1