Date:

To Whom It May Concern at WSDA,

I, You Name, hereby request an Emergency Hearing regarding my property at:

Insert your address

You are herby on notice that I have requested an Emergency Hearing and you shall respond as according to and within time frames within the Administrative Code.

I request legal counsel before any action or statements will be made.

My legal counsel is:

Insert Your Legal Counsel

Sign

Celeste Bishop