Osah Form 1 - Grec Application Form
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1OSAH FORM 1
This form is available online at
or by telephone request at (404)657-2800.
OSAH USE ONLY
AGENCY CODE
CASE TYPE
DOCKET NUMBER
COUNTY
JUDGE
DOCKET NUMBER:
GREC
GEORGIA REAL ESTATE COMMISSION
NAME OF REFERRING AGENCY:
COUNTY OF NON-AGENCY PARTY’S RESIDENCE OR PRINCIPAL PLACE OF BUSINESS: ___________________
SELECT CASE TYPE:
§ 43-40-25.2)
CEASE (OCGA § 43-40-30)
CIT (Citation OCGA
§ 43-40-16)
§ 43-40-25)
DEN (Denial of License OCGA
SAN (Sanction OCGA
DATE OF REQUEST FOR HEARING: _________________________
CONTACT PERSON IN REFERRING AGENCY
NAME:
TEL NO:
FAX NO:
POSITION
EMAIL:
CURRENT ADDRESS INCLUDING ZIP CODE ON HEARING REQUEST
PAGER:
ATTORNEY FOR REFERRING AGENCY
ATTORNEY NAME:
TEL NO:
FAX NO:
EMAIL:
CURRENT ADDRESS INCLUDING ZIP CODE
GEORGIA BAR NO:
PAGER:
NON-AGENCY PARTY -- (TO OSAH CLERK: IN DEN, PARTY IS APPLICANT)
NAME:
TEL NO:
FAX NO:
EMAIL:
CURRENT ADDRESS INCLUDING ZIP CODE ON HEARING REQUEST
PAGER:
NON-AGENCY PARTY’S ATTORNEY -- (TO OSAH CLERK: IN DEN, PARTY IS APPLICANT)
ATTORNEY NAME:
TEL NO:
FAX NO:
EMAIL:
CURRENT ADDRESS INCLUDING ZIP CODE
GEORGIA BAR NO:
PAGER:
PARTY REQUESTING THE HEARING:
REFERRING AGENCY
NON-AGENCY PARTY
NON-AGENCY PARTY’S ATTORNEY
FOR PUPOSES OF THIS HEARING, THE PARTY INDICATED WILL BE
:
PETITIONER
RESPONDENT IN THIS MATTER.
DOCUMENT INITIATING THE HEARING:
As “Attachment 1” to this form, attach the document initiating the hearing.
ISSUES TO BE RESOLVED:
As “Attachment 2”, attach an outline of legal issues and factual matters to be resolved at the hearing
including specific statutes or rules to be applied at the hearing.
SPECIAL REQUIREMENTS:
As “Attachment 3”, attach a sheet identifying any statutes or rule (state of federal) establishing any
specific time deadlines or procedures that are to be applied by OSAH in resolving the matter referred.
SERVICE OF DOCUMENTS:
In addition to routine service on the agency’s attorney, the agency contact person requests the following:
No service of documents prior to certification of the file to the agency after a decision
Service of all documents prior to certification of the file to the agency after a decision
Service of a copy of the notice of hearing
Service of a copy of a continuance
Service of copy of any interim orders.
All documents will be mailed to the referring agency at the address indicated for the contact person to the contact
person’s attention unless written instructions provide an alternative place for service.
GREC OSAH FORM 1 Revised 7/30/02
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