UNITED STATES COURT OF APPEALS SIXTH CIRCUIT ( ) APPLICATION FOR ENFORCEMENT OF AGENCY ACTION ( ) PETITION FOR REVIEW OF AGENCY ACTION Complete both pages of this form. Type or print. Attach additional pages, if necessary. TITLE OF ACTION, IN FULL AGENCY DISPOSITION Name of Agency: Agency case number: Date order entered: Court of Appeals Jurisdiction: _____U.S.C.A.___________ If petitioner is not a party to agency proceedings, specify standing: Has this matter been before this Court previously? ( )Yes ( )No If yes, state Case Name: Citation: Case Number: ADDRESSES TELEPHONE Petitioner(s) v. Respondent(s) ATTORNEYS Petitioner: NAMES Respondents: ( ( ( ( ( ) ) ) ) ) NATURE OF ORDER OF WHICH REVIEW OR ENFORCEMENT IS SOUGHT Administrative Regulation/Rulemaking ( ) Routes: Communication/Commerce Benefits Review ( ) Tariffs Health and Safety ( ) Unfair Labor Practice Immigration ( ) Employer Other (Specify) ( ) Union Page 1 of 1 American LegalNet, Inc. www.USCourtForms.com 6CA-54 2/86 CONCISE DESCRIPTION OF PROCEEDINGS BELOW AND ORDER TO BE REVIEWED OR ENFORCED. (Note those parts for the order from which relief is sought): ISSUES PROPOSED TO BE RAISED ON PETITION OR APPLICATION: RELIEF SOUGHT: To your knowledge, is there any case now pending or about to be brought before this court or any other court or administrative agency which: Arises from substantially the same case or controversy as this action? ( )Yes ( )No Involves an issue that is substantially the same, similar or related to an issue in this action? ( )Yes ( )No If "yes" to either question, provide: Case Name: Agency: Citation: Case Number: This is to certify that this Pre-argument Statement was mailed to the Clerk of the United States Court of Appeals for the Sixth Circuit and a copy served on each party or their counsel of record this____day of_________________, 20___. _________________________________ Signature of Counsel 6CA-54 2/86 Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com