(2) The name, address, any e-mail address, telephone number, and any facsimile number of the petitioner.
(3) The name, address, any e-mail address, telephone number, and any facsimile number of the petitioner’s attorney or qualified representative if any.
(4) The statutory provision(s), agency rule(s), or agency order(s) on which the declaratory statement is sought.
(5) A description of how the statutes, rules, or orders may substantially affect the petitioner in the petitioner’s particular set of circumstances.
(6) The signature of the petitioner or of the petitioner’s attorney or qualified representive.
(7) The date.
