APPENDIX B

Petition For Declaratory Ruling On Rule No._____________________

________________________________________________________________

1. 1.   Petitioner

   Address:___________________________________________________

   Telephone:_________________________________________________

2. 2.   All rules or statutes that may be involved in the petition, if known:  _____________________________________________________

   ________________________________________________________________

3. 3.   Clear and concise statement of the precise factual situation involved: ______________________________________________________ ________________________________________________________________

4. 4.   The exact question to which an answer is desired:

   ________________________________________________________________

   ________________________________________________________________

5. 5.   The reason for submitting the petition:____________________

   ________________________________________________________________

6. 6.   Full disclosure of the petitioner's interest:______________

   ________________________________________________________________

7. 7.   Statement as to whether the petitioner's case is presently under consideration by the Board or in any pending proceedings:

   ________________________________________________________________

   ________________________________________________________________

   ________________________________________________________________

8. 8.   Affidavit Certification Signature of Petitioner

   ________________________________________________________________

   Sworn to and subscribed before me this _________ day of_________________, 20______.

Statutory Authority: Code of Ala. 1975, §§

History: New Appendix: Filed February 11, 2011; effective March 18, 2011.