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          44:62:01:01.  Form of petition for declaratory ruling. A person may request a ruling as to the applicability of a statute or rule issued by the Department of Health by filing a written petition in substantially the following form:

South Dakota Department of Health

Petition for Declaratory Ruling

          Pursuant to the provisions of SDCL 1-26-15, (name of petitioner), (title or capacity of petitioner), (address of petitioner), does hereby petition the South Dakota Department of Health to issue a declaratory ruling in regard to the following:

          1.  The statute or rule in question is: (identify and quote the pertinent statute or rule).

          2.  The facts and circumstances which give rise to the issue to be answered by the department are:

          3.  The precise issue to be answered by the department is:

          Dated at (city and state), this _______ day of ___________, 19____.


(Signature of petitioner)


          Source: 21 SDR 85, effective October 16, 1994.

          General Authority:SDCL 34-1-25.

          Law Implemented:SDCL 1-26-15.

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