Fillable Petition for Declaratory Order by the Boiler and (Office of the Chief Information Officer)

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Petition for Declaratory Order by the Boiler and (Office of the Chief Information Officer)

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1
Petition for Declaratory Order by
the Boiler and Pressure Vessel Board
Notice: This document affects your legal rights. You may wish to consult an attorney
before completing this document. For more information, please read the boiler board’s rule
on declaratory orders at 875 Iowa Administrative Code Chapter 83.
Your name: ______________________________________________________________
Your title: ________________________________________________________________
Name of the organization you represent, if applicable: _____________________________
Your phone number: _______________________________________________________
Your e-mail address: _______________________________________________________
Your address: ____________________________________________________________
________________________________________________________________________
Describe the hypothetical facts on which you want the board to rule. _________________
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04-07
Cite the language of the statute, rule, policy, decision or order you are asking to board to
apply to your set of facts. ___________________________________________________
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List the questions you want the board to answer. ________________________________
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For each question, state the answer you prefer and the reasons supporting your answers.
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Why are you requesting the declaratory order and what is your interest in the outcome?
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Are you currently a party to any legal case or proceeding involving the questions above?
Yes No
Are the questions above under investigation by any governmental entity?
Yes No
Are the questions above pending before any governmental entity?
Yes No
2
04-07
List the names and address of all people known by you who will be affected by or interested
in the questions listed above. If a number of other people will be affected or interested, but
you do not know their names and addresses, please describe the group.
_________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________
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_________________________________________________________________________
(Optional)
If someone else will be the contact person for this petition, please provide the following:
Contact person’s name: _____________________________________________________
Contact person’s title: _______________________________________________________
Contact person’s telephone number: ___________________________________________
Contact person’s e-mail address: ______________________________________________
Contact person’s address: ___________________________________________________
Mail this form with a copy of relevant
documents you wish the board to consider
to:
Boiler and Pressure Vessel Board
Iowa Division of Labor
1000 East Grand Avenue
Des Moines, Iowa 50319-0209
___________________________________
Your signature
__________________________________
Date
3
04-07
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Petition for Declaratory Order by the Boiler and (Office of the Chief Information Officer)

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Completed 20 July 2020

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