PETITION FOR JUDICIAL REVIEW OF LICENSING DECISION

CAPTION

CIRCUIT OR SUPERIOR COURT OF INDIANA
[PETITIONER/LICENSEE], Petitioner,
v.
[AGENCY/BOARD NAME], Respondent.
Case No.: [___]

INTRODUCTION

• Petition for judicial review challenging Respondent's [Denial/Discipline/Suspension/Revocation] of [License Type] issued [DATE].

JURISDICTION, VENUE, AND TIMELINESS

• Jurisdiction under the Indiana Administrative Orders and Procedures Act (IC 4-21.5) and applicable licensing statutes.
• Petition timely under [licensing statute/agency rule].
• Administrative remedies exhausted.

PARTIES

• Petitioner [Name], license number [___].
• Respondent [Agency/Board], state agency located in [County/City].

PROCEDURAL HISTORY

• Summary of accusation/notice, hearing date(s), proposed decision, Board adoption/modification, and service of final decision on [DATE].

STANDARD AND GROUNDS

• Decision not supported by substantial evidence.
• Errors of law, procedural defects, due process violations.

RELIEF REQUESTED

• Issue order directing Respondent to vacate the decision and [reinstate license/issue license/remand].
• Stay enforcement pending review.
• Costs and other relief as just.

VERIFICATION AND SIGNATURE

• Verification per applicable rules; signature of Petitioner/counsel; proof of service on Respondent.