PETITION FOR ADOPTION OF RULE

1. I.  Petitioner

   Name:____________________________________________________

   Address:_________________________________________________

   Phone:___________________________________________________

   ______________________________________________________________

2. II.  Character of Change

   1. A. ( ) adopt the following new rule.
   2. B. ( ) amend Rule_____________________________as follows.

   3. C. ( ) repeal Rule______________________________in total.

      ______________________________________________________________

   I propose that the Child Abuse and Neglect Prevention Board

3. III. Text of Proposed Rule

   If you checked box "A" above, type the rule you propose in  the space below. If you checked box "B" above, type the currently  effective rule in the space below, adding any proposed language.  Proposed new language should be underlined and proposed deletions  should be striken through. For example, if a rule currently  provides that "Board meetings are held on Mondays and Fridays"  and you wish to change meeting days to Tuesdays and Fridays, you  should type below "Board meetings are held Mondays and Fridays."  If you checked box "C" above, skip this and go to Part IV. (Use  additional sheets if necessary).

   _____________________________________________________________

4. IV.  Purpose of Change

   Briefly describe what the effect of this change will be and  why you believe the change should be made. (Use additional sheets  if necessary).

   ______________________________________________________________

5. V.  Signature

   ____________________    ______________________
   Petitioner                       Date

   
   AFFIDAVIT 

   STATE OF ALABAMA)
   (________________)

   Before me,______________________________________________,  a Notary Public in and for said State and  County,  personally  appeared,____________________________________, who  being  made  known  to  me,  and  being  informed  of  the contents of this  petition  and the statements  by him/her therein, and being by  me duly sworn, says such statements are true and correct.

   Sworn to and subscribed before me this________________ day  of________________, 19_____.

   _______________________________________
   Signature of Notary Public