STATE OF NEW YORK
[NAME OF STATE ADMINISTRATIVE COURT/TRIBUNAL]
____________
In the Matter of the Application of
[PETITIONER LEGAL NAME],
Petitioner,
For an Administrative Appeal pursuant to New York State Administrative Procedure Act § 307 and Article 78 of the New York Civil Practice Law and Rules,
-against-
[FULL LEGAL NAME OF AGENCY],
Respondent.
Index No.: ____
Verified Petition
Effective Date: [DATE]
[// GUIDANCE: Select the proper tribunal—e.g., “Supreme Court of the State of New York, County of _____” for an Article 78 proceeding, or the named internal appeals board if the agency maintains one.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
3.1 Jurisdiction & Venue
3.2 Timeliness & Exhaustion Statement
3.3 Statement of Facts
3.4 Grounds for Relief
3.5 Relief Requested - Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
1.1 Parties Identification.
(a) Petitioner: [PETITIONER LEGAL NAME], a [ENTITY TYPE] with principal place of business at [ADDRESS].
(b) Respondent: [AGENCY LEGAL NAME], an administrative agency of the State of New York with offices at [ADDRESS].
1.2 Recitals.
A. On [DATE OF UNDERLYING AGENCY DETERMINATION], Respondent issued a final determination (“Determination”) adverse to Petitioner.
B. Petitioner timely seeks administrative-judicial review of the Determination pursuant to N.Y. State Admin. Proc. Act § 307 and N.Y. C.P.L.R. art. 78 (McKinney).
C. Petitioner has exhausted all administrative remedies available within the Agency, or such exhaustion is excused as set forth herein.
1.3 Effective Date; Governing Law.
This Petition is effective as of [FILING DATE] and is governed by New York State administrative law.
2. DEFINITIONS
For purposes of this Petition, the following terms have the meanings set forth below. Capitalized terms used but not defined herein have the meanings ascribed in the New York State Administrative Procedure Act or the CPLR, as applicable.
“Agency Record” means the complete record of proceedings before Respondent, including transcripts, exhibits, findings of fact, and rulings.
“Determination” means the final agency action issued on [DATE], referenced in Recital A.
“Exhaustion Requirement” means the obligation under New York law that a petitioner pursue and complete all internal administrative remedies before seeking judicial review, unless such requirement is lawfully waived or excused.
[// GUIDANCE: Add or delete defined terms to align with the facts of the underlying matter.]
3. OPERATIVE PROVISIONS
3.1 Jurisdiction & Venue.
3.1.1 This tribunal has subject-matter jurisdiction under N.Y. State Admin. Proc. Act § 307(1) and N.Y. C.P.L.R. § 7804(b).
3.1.2 Venue is proper in [COUNTY] because the material events occurred therein and/or Respondent maintains its principal office in said county.
3.2 Timeliness & Exhaustion Statement.
3.2.1 The Determination constitutes a “final and binding” agency action triggering the four-month statute of limitations under N.Y. C.P.L.R. § 217(1).
3.2.2 This Petition is filed within said limitations period.
3.2.3 Petitioner [HAS/HAS NOT] completed all internal administrative appeals. If not, exhaustion is excused because:
(a) Further pursuit would be futile; or
(b) No adequate administrative remedy exists; or
(c) The question presented is purely of law.
3.3 Statement of Facts.
[Provide concise chronological narrative of the underlying proceedings, citing to pages of the Agency Record where available.]
3.4 Grounds for Relief.
Pursuant to N.Y. C.P.L.R. § 7803, Respondent’s Determination should be annulled, modified, or remanded on one or more of the following grounds:
(a) Error of Law – The Determination is affected by an error of law.
(b) Arbitrary and Capricious – The Determination lacks a rational basis or reasonable justification.
(c) Substantial Evidence – The Determination is not supported by substantial evidence in the record.
(d) Abuse of Discretion – Respondent acted in excess of its jurisdiction or failed to follow lawful procedure.
3.5 Relief Requested.
Petitioner respectfully requests that the Court/Tribunal enter judgment:
(i) Vacating and annulling the Determination;
(ii) Remanding the matter to Respondent with instructions consistent with the Court’s findings;
(iii) Awarding costs and disbursements under N.Y. C.P.L.R. § 7806; and
(iv) Granting such other and further relief as the Court deems just and proper.
4. REPRESENTATIONS & WARRANTIES
4.1 Authority. Petitioner possesses full legal right and authority to prosecute this appeal.
4.2 Accuracy of Filings. All factual statements herein and in the supporting verification are true and correct to the best of Petitioner’s knowledge, information, and belief.
4.3 Completeness of Record. Petitioner has requested that Respondent compile and transmit the complete Agency Record forthwith.
5. COVENANTS & RESTRICTIONS
5.1 Service of Process. Petitioner shall serve this Petition, together with any Notice of Petition or Order to Show Cause, upon Respondent and the Office of the Attorney General in the manner prescribed by N.Y. C.P.L.R. § 7804(c).
5.2 Record Perfection. Petitioner shall take all reasonable steps to ensure that the Agency Record is filed with the Court within the period fixed by the Clerk or Justice.
5.3 Compliance with Scheduling Orders. The parties shall comply with any briefing schedule established by the Court.
6. DEFAULT & REMEDIES
6.1 Respondent Default. If Respondent fails to file the Agency Record or opposition papers by the deadlines set by law or Court order, Petitioner may move for summary judgment on the pleadings, costs, and any additional relief deemed appropriate.
6.2 Petitioner Default. Failure by Petitioner to prosecute this appeal diligently may result in dismissal under N.Y. C.P.L.R. § 3216.
7. RISK ALLOCATION
7.1 Administrative Penalties. This proceeding concerns administrative penalties only. No damages are sought beyond statutory costs and disbursements.
7.2 Indemnification. Not applicable to this administrative appeal.
8. DISPUTE RESOLUTION
8.1 Governing Law. All issues are governed by the laws of the State of New York.
8.2 Forum Selection. Exclusive jurisdiction lies with this state administrative tribunal or, where applicable, the Supreme Court of the State of New York, County of [COUNTY].
8.3 Arbitration. Not available for Article 78 or equivalent administrative appeals.
8.4 Jury Waiver. No jury trial is available in this administrative proceeding.
8.5 Injunctive Relief. The Court retains power to grant preliminary or permanent injunctive relief to preserve the status quo pending determination of this Petition.
9. GENERAL PROVISIONS
9.1 Amendment and Waiver. Amendments to this Petition require leave of Court pursuant to N.Y. C.P.L.R. § 3025.
9.2 Severability. If any provision of this Petition is held invalid, the remaining provisions shall remain in full force and effect to the maximum extent permitted by law.
9.3 Integration. This document, together with any supporting affidavits, exhibits, and memorandum of law, constitutes the entire submission of Petitioner in support of the relief requested.
9.4 Electronic Filing. This Petition may be filed and served electronically as permitted by the Court’s e-filing rules.
10. EXECUTION BLOCK
DATED: [DATE]
LOCATION: [COUNTY], New York
Respectfully submitted,
[NAME OF COUNSEL]
Attorney for Petitioner
[FIRM NAME]
[ADDRESS]
[PHONE]
[EMAIL]
NYS Bar No.: __
VERIFICATION
State of New York )
County of _ ) ss.:
[NAME], being duly sworn, deposes and says: I am the [TITLE/POSITION] of Petitioner in the above-captioned matter; I have read the foregoing Petition and know the contents thereof; the same are true to my knowledge, except as to matters stated to be alleged on information and belief, and as to those matters I believe them to be true.
[NAME OF VERIFYING PARTY]
Sworn to before me this ___ day of __, 20.
Notary Public
[// GUIDANCE: If the petitioner is an entity, the verification may be executed by an officer; if an individual, by the petitioner personally.]
OPTIONAL: NOTICE OF PETITION / ORDER TO SHOW CAUSE
[// GUIDANCE: New York practice generally requires either a Notice of Petition fixing the return date under CPLR 7804 or an Order to Show Cause signed by the Court. Tailor to local rules.]
END OF TEMPLATE
[// GUIDANCE:
1. Confirm that service requirements under CPLR 7804(c) are followed (personal delivery, certified mail, or as otherwise ordered).
2. Check county-specific Commercial Division or E-Filing rules where applicable.
3. Calendar the four-month statute of limitations meticulously.
4. Attach as exhibits: (a) the Determination; (b) relevant portions of the Agency Record; (c) any internal appeal decisions.
5. Adjust the “Grounds for Relief” to match the precise standard—e.g., “substantial evidence” review is required when the Determination followed a trial-type hearing pursuant to SAPA § 301 et seq.]