BEFORE THE [AGENCY NAME], STATE OF NEBRASKA
In the matter of)
the application of [name]) PETITION FOR
) DECLARATORY ORDER
)
1. Petitioner's name and address;
2. The name and address of all persons who or entities which may have a specific interest in the applicability of the statute, rule, regulation, or order, or who may be adversely affected by the issue sought to be resolved;
3. All material facts and specific circumstances;
4. All rules of law which apply;
5. Petitioner's demand for relief;
DATED on this __ day of ____, 199_ .
Neb. Admin. Code ATTORNEY GENERAL, tit. 53, ch. 3, app A