Form Apo-11 - Petition For A Contested Case Hearing
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2STATE OF HAWAII
BOARD OF LAND AND NATURAL RESOURCES
PETITION FOR A CONTESTED CASE HEARING
OFFICIAL USE ONLY
Case No.
Date Received
Board Action Date / Item No.
Division/Office
INSTRUCTIONS:
1.
File (deliver, mail or fax) this form within ten (10) days of the Board Action Date to:
Department of Land and Natural Resources
Administrative Proceedings Office
1151 Punchbowl Street, Room 130
Honolulu, Hawaii 96813
Phone: (808) 587-1496, Fax: (808) 587-0390
2. DLNR’s contested case hearing rules are listed under Chapter 13-1, HAR, and can be obtained from
the DLNR Administrative Proceedings Office or at its website
( ). Please review these rules before filing a petition.
3. If you use the electronic version of this form, note that the boxes are expandable to fit in your
statements. If you use the hardcopy form and need more space, you may attach additional sheets.
4. Pursuant to §13-1-30, HAR, a petition that involves a Conservation District Use Permit must be
accompanied with a $100.00 non-refundable filing fee (payable to “DLNR”) or a request for waiver
of this fee. A waiver may be granted by the Chairperson based on a petitioner’s financial hardship.
5. All materials, including this form, shall be submitted in three (3) photocopies.
A. PETITIONER
(If there are multiple petitioners, use one form for each.)
1. Name
2. Contact Person
3. Address
4. City
5. State and ZIP
6. Email
7. Phone
8. Fax
B. ATTORNEY (if represented)
9. Attorney Name
10. Firm Name
11. Address
12. City
13. State and ZIP
14. Email
15. Phone
16. Fax
FORM APO-11
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