§ 21.17 Appendix: Petition for Judicial Review of Agency Action

• Jurisdiction: Washington

§21.17 APPENDIX: PETITION FOR JUDICIAL REVIEW OF AGENCY ACTION

IN THE SUPERIOR COURT OF [***] COUNTY STATE
OF WASHINGTON

[Name of Petitioner],	)	NO. [***]
Petitioner	)
)	PETITION FOR JUDICIAL REVIEW
v.	)	OF AGENCY ACTION
)	[or] PETITION FOR DECLARATORY
[Name of Agency],	)	JUDGMENT ON THE VALIDITY OF
Respondent.	)	A RULE ADOPTED BY [Agency Name]
____________________	)

The Petitioner, [name], pursuant to Chapter 34.05 RCW, [seeks judicial review of agency action of the [agency name]] [or] [seeks a declaratory judgment on the validity of a rule adopted by the [agency name]]. Pursuant to RCW 34.05.546, the Petitioner states as follows:

1.	Name and mailing address of the Petitioner:
[add]
2.	Name and mailing address of Petitioner's attorney[s]:
[add]
3.	Name and address of the agency whose action is at issue:
[add]
4.	Identification of the agency action at issue:

The agency action at issue is the [describe the order, including rule-making order, or the agency's failure to perform a duty that gives rise to the petition]. A copy of the order [including order adopting a rule)] is attached as Appendix A to this Petition. That agency action was taken on [date]. [Or, if the basis for the petition is the agency's failure to perform a duty, reviewable under RCW 34.05.570(4), describe that situation and when it transpired.]

5. Identification of the parties (other than the agency) in the adjudicative proceedings that led to the agency action:

[add if applicable] [NOTE: This item usually does not apply to petitions challenging rules under RCW 34.05.570(2) and "other agency action" under RCW 34.05.570(4), because such actions typically are not "adjudicative proceedings."]

6. Jurisdiction:

This action is a judicial review of agency action by the [name the agency]. The court has jurisdiction over this matter pursuant to Part V of the Administrative Procedure Act, RCW 34.05. The filing of this petition for judicial review in the Superior Court of [name the county] is appropriate because [explain why the filing location is appropriate by satisfying the applicable filing location requirements, and cite RCW 34.05.514(1), (2), or (3), or RCW 34.05.570(2)(b), whichever applies].

7. Facts that...