To: State Appeal Board
State Capitol
Des Moines, lA 50319
We, the undersigned, protest the action of the officials of(local government)in certification of their 19_____-_____budget and request an appeal hearing.
We offer the following objections and reasons in summary form as basis for our appeal under Iowa Code chapter____:
Objection 1 (cite)
Reasons: (brief explanation)
Objection 2 (cite)
Reasons: (brief explanation)
(Add such other sections as needed to identify each basic objection and supporting reasons.)
Date Signatures Full mailing address with Zip code.
indicate "Protest to_____(local government)_____Budget,
19____-____.")
100.
Iowa Admin. Code r. 543-5.5