______________________________________________________________________
_______________________________________________________________________
5)____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________________________________________________________________
6)____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
________________________________________________________________________
7) Attached hereto are copies of relevant documents in support of petitioner's case,
including determination(s) issued by respondent(s) that have a bearing on this case and/or
of which petitioner herein complains, if any. [17. Identify all documents including written
decisions, determinations made by respondents that are relevant to this case.]
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________________________________________________________________
[18. Attach each document to this packet and label it as Exhibit A, Exhibit B, etc...
List Exhibits below]
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________________________________________________________________
8) A prior application [19. Check that a prior application has been made only if you are
seeking the same relief again] _____has or ____ has not been made for the relief
requested herein.
If a prior application has been made then provide the following
information [20. What Court, when, who made the application, the result of the
application, attach a copies of the application and explain why you are making
another application.]
______________________________________________________________________