Form 5. Petition for Review. DISTRICT OF COLUMBIA COURT OF APPEALS PETITION FOR REVIEW Appeal No.__________________ ________________________________, Petitioner v. _________________________________, Respondent (Agency)
_____________________ Agency No.
I, _______________________________, seek review by the District of Columbia Court of Appeals of the decision or order of _________________________________(agency) entered on the _________ day of _____________, 20____. Names, addresses, and telephone numbers of all other parties and their counsel who appeared in the agency (use additional pages if necessary) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
__________________________________ Signature of Petitioner or Attorney (all but natural persons representing themselves must be represented by counsel)
_________________________________ Printed Name of Petitioner or Attorney ____________________________________ ____________________________________ ____________________________________ Address ____________________________________ Telephone Number
NOTE: ATTACH A COPY OF THE DECISION/ORDER ISSUED BY THE DISTRICT OF COLUMBIA AGENCY FROM WHICH THE PETITION IS TAKEN.