Neb. Admin. Code BOARD OF BARBER EXAMINERS, tit. 51, ch. 16, app A
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 ________________, 2____.
VERIFICATION
STATE OF)
) ss.
COUNTY OF)
[name], being first duly sworn, states that he/she is the petitioner/petitioner's agent in the above entitled matter; that he/she has read the foregoing Petition For Declaratory Order; and that the allegations of fact therein are true.
____________________________________________
[Petitioner's signature]
SUBSCRIBED and sworn to before me on this day of
____________, 2____ .
NOTARY SEAL
[Notary signature]
Neb. Admin. Code BOARD OF BARBER EXAMINERS, tit. 51, ch. 16, app A