Home Table of Contents

Form 1. Notice of Appeal of Administrative Decision

Arizona Revised Statutes AnnotatedRules of Procedure for Judicial Review of Administrative Decisions

Arizona Revised Statutes Annotated
Rules of Procedure for Judicial Review of Administrative Decisions (Refs & Annos)
17C A.R.S. J. Review Admin. Dec., Form 1
Form 1. Notice of Appeal of Administrative Decision
A.R.S. §§ 12-901(2), 12-904, 12-906, 12-909(A),
12-914, JRAD Rule 4
Distribution:
Clerk of Superior Court--Original
Each Appellee--1 (served as provided
in Rule 4, Ariz. R. Civ. P.)
Time to File: Within 35 days from the date when a
copy of the final administrative decision, as defined
in A.R.S. § 12-901(2), sought to be reviewed is
served upon the party affected.
Attorney or Party Name
State Bar No. (if any)
Law Firm Name (if any)
Complete Mailing Address
Telephone Number
Email Address
Attorney for __________ (party name)
SUPERIOR COURT OF ARIZONA
____________________ COUNTY
 
)
Appellant(s),
)
Case No. __________
)
vs.
)
NOTICE OF APPEAL FOR
 
)
JUDICIAL REVIEW OF
)
ADMINISTRATIVE DECISION
Appellee(s).
)
(Administrative Review)
)
Pursuant to A.R.S. § 12-904, [name of Appellant(s)] appeals from the final administrative decision [name of final decision] issued by [name of agency] on [date] in cause no. __________ [agency docket number or case number].
Pursuant to JRAD Rule 4, the following items are included in this Notice of Appeal:
1. The caption of the case and the administrative agency case number are _______________.
2. The party or parties filing the appeal are as follows: _______________.
3. The final administrative decision from which the party is appealing is _______________, which was issued on _______________.
4. The findings and decision or part of the findings and decision sought to be reviewed is as follows _______________.
5. The issues presented for review are as follows:
 
.
6. A request for trial de novo, is/is not requested.
[Appellant requests an award of attorney's fees incurred pursuant to (specify substantive authority that authorizes the fee award).]
DATED this day of ______________________________, 20 _____
 
 
Signature of Attorney or
Self-Represented Party
The following parties appeared before the agency:

Credits

Added Aug. 31, 2017, effective Jan. 1, 2018.
17C A. R. S. J. Review Admin. Dec., Form 1, AZ ST J REVIEW ADMIN DEC Form 1
Current with amendments received through 11/1/19
End of Document© 2019 Thomson Reuters. No claim to original U.S. Government Works.