Administrative Hearings, Office of

General Agency, Board or Commission Rules

Chapter 0: Appendix A & B

Effective Date: 11/18/2002 to 10/17/2014

Rule Type: Superceded Rules & Regulations

Reference Number: 270.0001.0.11182002

APPENDIX A

GENERAL FORM TRANSMITTAL SHEET (SEE CHAPTER 2, SECTION 1, OF OAH RULES)

TO: OFFICE OF ADMINISTRATIVE HEARINGS DATE:

FROM:

(REFERRING AGENCY AND AGENCY NUMBER)

YOU MUST INCLUDE A COPY OF YOUR AGENCY CASE FILE (DO NOT SEND ORIGINAL) AND RELEVANT AGENCY RULES WITH THIS TRANSMITTAL.

PLEASE IDENTIFY THE PARTIES AND, IF KNOWN, THEIR ATTORNEYS AND THEIR MAILING ADDRESSES AND TELEPHONE NUMBERS:

PLEASE PROVIDE A SHORT STATEMENT OF THE NATURE OF THIS CASE:

ARE THERE STATUTORY LIMITS ON THE TIME FOR HEARING OR DECISION IN THIS CASE? YES ☐ NO ☐ IF YES, PLEASE EXPLAIN:

HAS ANY PARTY TO THIS CASE REQUESTED INTERIM, EXPEDITED OR EMERGENCY RELIEF? YES ☐ NO ☐ IF YES, PLEASE EXPLAIN:

WHO IN YOUR AGENCY SHOULD WE CONTACT FOR SCHEDULING?

WHO IN YOUR AGENCY SHOULD WE CONTACT FOR BILLING?

I HEREBY CERTIFY THAT AS AN AUTHORIZED OFFICER OF THE REFERRING AGENCY, ALL PARTIES HAVE BEEN PROPERLY SERVED WITH A TRUE AND COMPLETE COPY OF THIS TRANSMITTAL SHEET ON THE _ DAY OF _, 20__.

SIGNATURE AND TITLE OF AUTHORIZED OFFICER

APPENDIX B

IN THE OFFICE OF ADMINISTRATIVE HEARINGS

STATE OF WYOMING

COUNTY OF

SUBPOENA

To: (WITNESS)

You are hereby commanded to appear on the day of , 20 , at the hour of o'clock m. at (LOCATION OF HEARING) to testify as a witness at the request of (PARTY REQUESTING SUBPOENA) in a cause now pending (DESCRIBE PROCEEDING) and this you are not to omit under penalty of the law.

WITNESS, a Hearing Examiner in the Office of Administrative Hearings, this day of , 20 .

OFFICE OF ADMINISTRATIVE HEARINGS

BY: Hearing Examiner

CERTIFICATE OF SERVICE

Comes now (PERSON SERVING SUBPOENA) , who certifies that he served a true copy of the above Subpoena on (IDENTIFY PERSON SERVED AND DESCRIBE MANNER OF SERVICE) at the hour of o'clock m. the day of , 20 .

Dated this day of , 20 .

(SIGNATURE OF PERSON SERVING SUBPOENA)