Name of Party/Representative
Mailing Address of Party/Representative
Street Address of Party/Representative (if different)
Telephone Number of Representative
E-mail Address of Representative
Attorney/Representative for [Name of Party] (if needed)
BEFORE THE [NAME OF AGENCY]
[Title of Proceeding]
CASE NO. [Case number assigned by agency]
[TITLE OF DOCUMENT]
Idaho Admin. Code r. 62.01.01.302