201—11.2(17A) Petition for declaratory rulings. A petition for a declaratory ruling shall be filed in the director’s office, Department of Corrections, 510 East 12th Street, Des Moines, Iowa 50319. The petition shall either be mailed certified, return receipt requested, or delivered in person. An additional copy may be provided if the petitioner wishes to retain a filed stamped copy of the petition. The petition shall be typewritten and must substantially conform to the following:

DEPARTMENT OF CORRECTIONS
510 EAST 12TH STREET
DES MOINES, IOWA 50319	
Petition by ________(Name)__________
For a Declaratory Ruling on
(state statute, rule citation to be ruled on)	}	PETITION FOR
DECLARATORY RULING	
(Petition must state in separately numbered paragraphs)
	1.	Petitioner’s name, address and telephone number.
	2.	A clear, concise and complete statement of all relevant facts on which the ruling is requested.
	3.	A clear and concise statement of the controversy or uncertainty.
	4.	Reference to the statutory authority or rules in question, along with attached copies.
	5.	The reasons for prompting the petition and a full disclosure of petitioner’s interest.
	6.	Whether petitioner is currently a party to a contested case, rule making or judicial proceeding involving the controversy or uncertainty.
	7.	The names and addresses, when known, of other persons who may be affected by the declaratory ruling.

(Petitioner’s Signature)	
[ARC 3929C, IAB 8/1/18, effective 9/5/18; see Delay note at end of chapter]