Ariz. R. P. Jud. Rev. Admin. Decision. Form 7
A.R.S. § 12-904(B) | ||
Distribution: | ||
Clerk of Superior Court--Original | ||
Judge--1 | ||
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) | ||
SUPERIOR COURT OF ARIZONA
____________________ COUNTY
_________ | ) | ||
Appellant, | ) | Case No. __________ | |
) | |||
vs. | ) | CERTIFICATION OF | |
) | RECORD ON APPEAL | ||
) | |||
Appellee. | ) | ||
) |
I am the agency head [name of agency] or duly authorized representative, and I certify that:
1. Attached to this Certification is an index of all materials contained in the record on appeal.
2. The materials included in the record on appeal are originals or accurate copies.
The information provided in this Certification is true and complete.
DATED this __________ day of ______________________________, 20_____
Signature of Agency Head or Duly-Authorized Representative
Copy of the foregoing [mailed/delivered]
this _____ day of __________, 20 ___, to:
[Attorney or Party Name]
by: ______________________________
Ariz. R. P. Jud. Rev. Admin. Decision. Form 7