Section 12.39 Form 3—Petition for Review of an Order of an Agency, Board, Commission, or Officer

• Library: App Ct Prac 2013 Supp - Forms

This form is available at:

www.uscourts.gov/uscourts/rules/appellate-procedure.pdf

United States Court of Appeals

for the ___________ Circuit

A.B., Petitioner )

)

v. ) Petition for Review

)

XYZ Commission, )

Respondent )

A.B. hereby petitions the court for review of the Order of the XYZ Commission (describe the order) entered on _______________, 20____.

(s)_____________________________

Attorney for Petitioners

Address: ______________________