PROFESSIONAL LICENSING APPEAL – GEORGIA

CAPTION

Before [Agency/Board or OSAH]
[LICENSEE NAME], Petitioner,
v.
[AGENCY/BOARD NAME], Respondent.

INTRODUCTION

• Challenge to [Denial/Discipline/Suspension/Revocation] of [License Type] dated [DATE].

JURISDICTION AND TIMELINESS

• Filed within [30] days under O.C.G.A. § 50-13-19 (Georgia APA) or applicable agency rule; exhaustion satisfied.

VENUE

• Superior Court of [Fulton County / county of residence if permitted] per O.C.G.A. § 50-13-19(b).

ISSUES PRESENTED

• [Issue 1]
• [Issue 2] (as needed)

STATEMENT OF FACTS

• Chronology of application/discipline, notices, hearings, findings.

ERRORS AND ARGUMENT

• Decision not supported by substantial evidence; arbitrary/capricious; errors of law under [cite].
• Due process concerns if notice/opportunity to be heard was deficient.

RELIEF REQUESTED

• Reverse/modify decision; reinstate/grant license; remand if necessary; stay requested [Yes/No].

EXHIBITS

• Determination/order; transcript excerpts; affidavits; key record exhibits.

SERVICE

• Serve agency and Attorney General/agency counsel per O.C.G.A. § 50-13-19 and court rules; include certificate of service.

SIGNATURE

[Name, Bar No.]
[Address, Email, Phone]
Counsel for [LICENSEE]