A request for review of Department determination of issues under 1 DOM/RR Section 761.12(h) shall include:
- (1) A clear statement of the facts entitling that person to administrative relief;
- (2) An explanation of the alleged errors in the Department's decision;
- (3) A request for specific relief;
- (4) A statement whether the person requests or waives the opportunity for an evidentiary hearing; and
- (5) Any other relevant information.