Ariz. R. P. Jud. Rev. Admin. Decision. Form 6
A.R.S. § 12-904(B), JRAD Rule 4(f) | ||
Distribution: | ||
Clerk of Superior Court--Original | ||
Administrative Agency--1 | ||
Each party--1 | ||
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) | ||
OFFICE OF ADMINISTRATIVE HEARINGS OR
NAME OF AGENCY
) | |||
Appellant, | ) | Case No. __________ | |
) | |||
vs. | ) | NOTICE OF ACTION | |
) | (COMMENCEMENT OF THE APPEAL) | ||
) | |||
Appellee. | ) | ||
) |
[Appellant] gives notice pursuant to A.R.S. § 12-904(B) that Appellant has filed an action pursuant to the Judicial Review of Administrative Decisions Act, A.R.S. §§ 12-901 to--914 to appeal the decision of [name of agency] dated [date entered].
DATED this ___ day of __________, 20 ___
_____________________________
Signature of Attorney or Self-Represented Party
Copy of the foregoing [mailed/delivered]
this _____ day of __________, 20 ___, to:
[Attorney or Party Name]
by: ______________________________
Ariz. R. P. Jud. Rev. Admin. Decision. Form 6