OSAH FORM 1 - Georgia Office of State Administrative Hearings
OSAH FORM 1
This form is available online at or by telephone request at (404) 657-2800.
|OSAH USE ONLY |AGENCY CODE |CASE TYPE |DOCKET NUMBER |COUNTY |JUDGE |
|DOCKET NUMBER: |GGTACFC | | | | |
GEORGIA GOVERNMENT TRANSPARENCY AND CAMPAIGN FINANCE COMMISSION
|Case Type: |
| RV (Registration Violation) CAN (Candidate) LOBB (Lobbyist) VEN (Vendor) Other |
|FDV (Finance Disclosure Violation) NCAN (Non-Candidate/Independent Committee) |
|Relief Sought: |
| Cease and desist order |
|Order Requiring Defendant to make public complete statements, in corrected form |
|Civil penalty not to exceed $1,000.00 for first violation |
|Civil penalty not to exceed $10,000.00 for a second occurrence of a violation of the same provision |
|Civil penalty not to exceed $25,000.00 for each third or subsequent occurrence of a violation of the same provision |
|Denial, suspension or revocation of the registration of a lobbyist |
|Award attorneys' fees |
|Other |
DATE COMPLAINT FILED WITH COMMISSION: COUNTY OF ALLEGED VIOLATOR:
CONTACT PERSON IN COMMISSION:
|NAME: |TEL NO: |FAX NO: |
| | | |
|CURRENT ADDRESS INCLUDING ZIP CODE ON HEARING REQUEST |POSITION |EMAIL: |
| | | |
| | |PAGER: |
PLAINTIFF:
|NAME: |TEL NO: |FAX NO: |
| | | |
|CURRENT ADDRESS INCLUDING ZIP CODE ON HEARING REQUEST |POSITION |EMAIL: |
| | | |
| | |PAGER: |
PLAINTIFF’S ATTORNEY:
|ATTORNEY NAME: |TEL NO: |FAX NO: |
| | | |
|CURRENT ADDRESS INCLUDING ZIP CODE ON HEARING REQUEST |GEORGIA BAR NO: |EMAIL: |
| | | |
| | |PAGER: |
DEFENDANT:
|NAME: |TEL NO: |FAX NO: |
| | | |
|CURRENT ADDRESS INCLUDING ZIP CODE ON HEARING REQUEST | |EMAIL: |
| | | |
| | |PAGER: |
DEFENDANT’S ATTORNEY:
|NAME: |TEL NO: |FAX NO: |
| | | |
|CURRENT ADDRESS INCLUDING ZIP CODE ON HEARING REQUEST |GEORGIA BAR NO: |EMAIL: |
| | | |
| | |PAGER: |
* The verified Complaint initiating the action and proof of service on Defendant must be attached to this Form and mailed to:
Clerk of Court
Georgia Office of State Administrative Hearings
225 Peachtree Street, NE, South Tower, Suite 400
Atlanta, GA 30303
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