BEFORE THE OFFICE OF STATE ADMINISTRATIVE HEARINGS

STATE OF GEORGIA

Petitioner(s),
Docket No.: _________________________
v.

Respondent(s).

REQUEST TO USE A RECORDING DEVICE

Pursuant to OSAH Rule 43, the undersigned hereby requests permission to use a recording

device in order to record images and/or sound during proceedings in the above captioned case.

Consistent with the provisions of Rule 22 of the Uniform Rules for the Superior Courts,

the undersigned desires to use the following recording device(s):

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

The proceedings that the undersigned desires to record commence on __________. Subject

to direction from the court regarding possible pooled coverage, the undersigned wishes to use this

device in the courtroom on ______________.

The personnel who will be responsible for the use of this recording device are:

____________________________________________________________________

____________________________________________________________________
 The undersigned hereby certifies that the device(s) to be used and the location(s) and

operation of such device(s) will be in conformity with Rule 22 and any guidelines issued by the

Court.

The undersigned understands and acknowledges that a violation of Rule 22 and any

guidelines issued by the Court may be grounds for removal or exclusion from the courtroom and

a willful violation may subject the undersigned to a civil penalty.

Respectfully submitted this _____ day of ____________, 20___.

______________________________
(Signature)

______________________________
(Printed Name)