(Date) _______________________________
Drug Enforcement Administration, Attn: Hearing Clerk/OALJ
(Mailing Address) _______________________________
Subject: Request for Hearing
Dear Sir:
The undersigned ___ (Name of the Person) hereby requests a hearing in the matter of: ___ (Identification of the proceeding).
(State with particularity the interest of the person in the proceeding.)
All notices to be sent pursuant to the proceeding should be addressed to:
(Name) _______________________________
(Street Address) _______________________________
(City and State) _______________________________
Respectfully yours,
(Signature of Person)_______________________________
21 C.F.R. §1316.47