Petition For Intervention {54361}

STATE OF INDIANA BEFORE THE INDIANA ALCOHOL & TOBACCO COMMISSION IN THE MATTER OF THE PERMIT OF: x x x Name of Permit d/b/a Address ) ) ) ) ) ) ) PERMIT NO. ______________ REMONSTRATOR'S OBJECTION, PETITION FOR INTERVENTION AND A REQUEST FOR APPEAL HEARING COMES NOW __________________________, and pursuant to 905 IAC 1-36-2, hereby moves the Alcohol & Tobacco Commission ("Commission") for permission to intervene in this cause as a remonstrator. In support of this petition, remonstrator would show the Commission the following: 1. This matter concerns a NEW APPLICATION/RENEWAL OF AN EXISTING PERMIT / TRANSFER OF OWNERSHIP / TRANSFER OF LOCATION (SELECT THE APPLICABLE) for a permit. 2. This matter was heard by the __________________ County Local Alcoholic Beverage Board ("Local Board") on the ______ day of ____________________, 20___, at which time the Local Board voted to recommend approval of the permit. 3. Remonstrator was present at the Local Board hearing and identified himself/herself to the Local Board and stated his/her name, address, and/or telephone number for the record. 4. The Commission adopted the Local Board's recommendation on the ____ day of ___________, 20____, and issued the permit. 5. Remonstrator received notice of the Commission's action on the _____ day of ____________, 20____. State Form 54361 (7-10) American LegalNet, Inc. www.FormsWorkFlow.com 6. Remonstrator objects to the Commission's decision and will be aggrieved or adversely affected by the Commission's decision on the grounds that it is: SET FORTH DETAILS ON WHY THE LOCAL BOARD'S DECISION WAS WRONG AND WHAT EVIDENCE, IF ANY, WAS OFFERED IN SUPPORT OF THIS POSITION, see 905 IAC 1-27 7. Remonstrator will be personally aggrieved or adversely affected if the permit is granted because: EXPLAIN HOW YOU WILL BE PERSONALLY AFFECTED BY THE ISSUANCE OF THIS PERMIT. Wherefore, the Remonstrator, ______________________________, prays the Commission for permission to intervene in this matter and objects to the Commission's actions and requests an appeal hearing before the Commission, and for any and all other just and proper relief. Respectfully submitted, __________________________________________ (Signature) __________________________________________________ (Name) __________________________________________________ (Address) __________________________________________________ (Telephone Number) State Form 54361 (7-10) American LegalNet, Inc. www.FormsWorkFlow.com