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APPENDIX A PRESCRIBED FORMS TABLE OF CONTENTS
APPENDIX A-2
I. Petitioner. Name: Address: Telephone:
II. Character of Change. I propose that the Home Builders Licensure Board A. ( ) adopt the following rule. B. ( ) amend rule as follows. C. ( ) repeal rule in total.
III. Text of Proposed Rule. If you check "A" above, attach a typed copy of the rule you propose. If you check "B" above, attach a typed copy of the
currently effective rule, adding any proposed language. Proposed new language should be
underlined and proposed deletions should be stricken through. For example, if a rule
currently provided that "Board meetings are held on Mondays and Fridays" and you
wish to change meeting days to Tuesdays and Fridays, you should type "Board meetings
are held on If you check "C" above, skip this and go to Part IV. (Use additional sheets if necessary.)
IV. Purpose of Change.
Briefly describe on additional sheets the effect of this change and why you believe the change should be made.
V. Signature. APPENDIX A-3
1. Petitioner. Name: Address: Telephone:
2. All rules or statutes that may be involved in the petition, if known:
3. Clear and concise statement of the precise factual situation involved:
4. The exact question to which an answer is desired:
5. The reason for submitting the petition:
6. Full disclosure of the petitioner's interest:
7. Statement as to whether the petitioner's case is presently under consideration by the Home Builders Licensure Board or in any pending proceeding:
8. Affidavit Certification: Signature of Petitioner Sworn to and subscribed before me this the ____ day of _____________, 19__.
(Notary Public) APPENDIX A-4 TABLE OF CONTENTS
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