Fill and Sign the Administrative Agency Form

IN THE ________________________ COURT OF __________________________ (County), _______________________________ (State) _______________________________________ PETITIONER (Name of Petitioner) V. CAUSE NO. _________,_________ _______________________________________ RESPONDENTS _______________________________________ _______________________________________ (Names of Respondents) PETITION COMES NOW _____________________________________ (Name of Petitioner) , Petitioner in the above-styled and numbered cause, by and through his attorney, and files this his Petition against Respondents ______________________________________________________ ______________________________________ (Names of Respondents) , and in support thereof would show unto the Court the following matters and facts: 1. Petitioner is an adult resident citizen of _______________________________________ ____________________________________ (city, county, state) . 2 . Respondent A is an adult resident citizen of ____________________________________ ____________________________________ (city, county, state) . Respondent B is an adult resident citizen of _______________________________________________________________ __________________________ (city, county, state) . Respondent C is an adult resident citizen of ___________________________________________________________________________ __________________________________ (city, county, state) . 3. On ______________________________________ (date) , Respondents A, B, and C were, and now are, the duly commissioned, qualified, and acting members of and constituting the __________________________________________________ (name of administrative agency), hereinafter called the Board . It is the official duty of Respondents , under ( cite applicable statute ) ________________________________________________ , to receive and approve or disapprove petitions (describe substance of petitions) __________________________________ ______________________________________________________________________________ _______________________________________________________________submitted to them. 4. On _________________________________ (date) , at ____________ ( time) , the Board was then and there in session at its regular (e.g., monthly) _______________________ meeting. On that date there was presented to the Board a petition (the Petition ) signed by ________________________________________ (Name of Petitioner) , setting forth, stating, and requesting that (summarize Petition) ____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. Said Petition was regular, correct, and complete in all respects as required by ( cite applicable statute ) _________________________________________________ . 5. By letter dated ____________________________ (date) , Respondents as such __________________________________________________ (name of administrative agency) informed Petitioner that the Petition submitted was disapproved by order of the Board dated ____________________________ (date) , on the grounds that (summarize grounds) _________ ______________________________________________________________________________ _____________________________________________________________________________. 6. Respondents as such _______________________________________________________ (name of administrative agency) did act arbitrarily in their disapproval of Petitioner's Petition, in that the following irregularities and violations of ( cite applicable statute ) ________________ _________________________ occurred: (summarize facts) ____________________________ ______________________________________________________________________________ _____________________________________________________________________________. 7. If Respondents , as such ____________________________________________________ (name of administrative agency) are not required to approve Petitioner's Petition in the manner and as required by law, Petitioner will suffer irreparable damage, for which there is no plain and adequate remedy at law. WHEREFORE, Petitioner requests the Court to grant and issue a peremptory Writ of Mandamus to Respondents compelling and commanding them as members of the Board to approve Petitioner's Petition, or, if the writ is refused, that an alternative Writ of Mandamus issue, compelling Respondents to approve or appear and show cause why Petitioner's Petition should not be approved, and that the Court provide such further relief to which Petitioner may be entitled. Respectfully submitted, ______________________________________ (Name of Petitioner) By: ____________________________________ _______________________________________ (Name & Signature of Petitioner’s Attorney) State Bar No. __________________ Petitioner’s Attorney OF COUNSEL: __________________________________ (Name of Petitioner’s Attorney) Post Office Box _______________ ___________________________________ City, State, Zip Code Telephone: ______________________