AUTHORIZED REPRESENTATIVE OR PARTY WITHOUT ATTORNEY (Name, Address, and Telephone): For ODL use only: STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS In the matter of the Request for Review of: Requesting Party, vs. Enforcing Agency. AUTHORIZATION FOR REPRESENTATION BY NON-ATTORNEY (Rule 9(b)) Case No.: - PWH (Name of Party) designates the following individual or firm, who is not an attorney at law,* to serve as our authorized representative in this matter and to receive all notices in our behalf unless and until this Authorization is terminated or withdrawn by further written notice. Specify Name, Address, and Telephone Number of Representative: Date: _________________________ ................................................ (TYPE OR PRINT NAME OF ! OWNER, MAKING THIS DESIGNATION) _____________________________________________ (SIGNATURE) ! OFFICER, OR ! MANAGING AGENT WHO IS Owner, Officer, or Managing Agent of Party I accept this authorization. Date: _________________________ _________________________________________ Authorized Representative * This form is not required for an authorized representative who is an Owner, Officer, or Managing Agent of the Party New 1/15/02 AUTHORIZATION FOR REPRESENTATION BY NON-ATTORNEY 8 CCR 17209(b) American LegalNet, Inc. www.FormsWorkflow.com