Section 1.ILLUSTRATION A   Petition

(DATE)

Director

Department of Agriculture

State Fairgrounds

Springfield, Illinois  62706

PETITION

            The undersigned submits this petition pursuant to (relevant statutory reference, if known) to request the Director of Agriculture to (amend, issue, or revoke a regulation or take or refrain from taking any other form of administrative action).

A)        Action Requested.

1)         If the petition requests the Director to issue, amend or revoke a rule or regulation, the exact wording of the proposed regulation or amendment requested.

2)         If the petition requests the Director to take or refrain from taking any other form of administrative action, the specific action or relief requested.

B)        Statement of Grounds.

            (A full statement of the factual and legal grounds upon which the petitioner relies. Such grounds shall include all relevant data, information and views on which the petitioner relies and fiscal implications, if applicable.)

            The undersigned certifies that, to the best of such person's knowledge and belief this petition includes all data, information and views on which the petition relies, and that it includes representative data and information known to the petitioner which are unfavorable to the petition.

Very truly yours,

(Signature)

(Complete Mailing Address)

(Telephone number)

(Source:  Amended at 16 Ill. Reg. 15850, effective October 5, 1992)