b) All responses shall be in writing. The response shall contain the following:

1. 1) The name, current address and current telephone number of the licensee;
2. 2) A clear and concise statement admitting or denying each of the factual allegations set forth in the notice of proposed disciplinary action, with each admission or denial being shown in separately numbered paragraphs corresponding to the separately numbered paragraphs in the notice of proposed disciplinary action;
3. 3) For all factual allegations that the licensee denies, a clear and concise statement of facts upon which the licensee relies or will rely on at a hearing;
4. 4) A signature of the licensee;

5. 5) A verification of the licensee in the following form:

   "The undersigned certifies that the statements set forth in this request are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he or she verily believes the same to be true."; and

6. 6) The response must be notarized.

f) The licensee may submit a response by:

1. 1) Personal delivery;
2. 2) Certified U.S. Mail, postage prepaid;
3. 3) Overnight express mail, postage prepaid; or
4. 4) E-mail.