BEFORE THE STATE REAL ESTATE COMMISSION
STATE OF NEBRASKA

In the Matter of              )
        
Statute Number/Name                      )        Petition for Negotiated
by            )               Rulemaking
       
Name of Petitioner                   
       )

        COMES NOW the Petitioner, , according to the Nebraska Negotiated
Rulemaking Act and according to the State Real Estate Commission rules and regulations for Petitions for Negotiated
Rulemaking, and requests that the State Real Estate Commission establish a negotiated rulemaking committee as set forth
in this Petition.

        In support of this request, the Petitioner states as follows:

        1.        The State Real Estate Commission administers the provisions of  [insert sections of the statutes or
legislative bill numbers for which negotiated rulemaking is sought]
,
and is responsible for development of rules and regulations to implement these statutes.

        2.        Petitioner seeks a negotiated rulemaking procedure to [check one] :

             develop new rules
                    amend existing rules, specifically N.A.C.,
                                                                                        Title                     Chapter-Section
                   
entitled .
           
       repeal  certain existing rules, specifically N.A.C. ,
                                                                                                 
     Title                      Chapter-Section
                          entitled .

         3.          A negotiated rulemaking committee should be established to negotiate and develop rules on each of
the following issues concerning the statute(s), legislative bill(s) or regulations(s) identified above [identify each issue
as to each statute, legislative bill or regulation and the general scope of the rulemaking proposed] :

       4.            The facts surrounding each of the issues listed in paragraph 3 above are as follows:

        5.              Establishment of a negotiated rulemaking committee would be in the public interest under each of the 
following criteria based upon the information the Petitioner hereby submits.
               
                        A.   There is a need for rulemaking on the issue(s) identified above because:

                        B.    There are a limited number of identifiable interests that will be significantly affected by the rule, 
including the following interests:

                  C.     There is a reasonable likelihood that a negotiated rulemaking committee can be convened with a 
balanced representation of people (1) who can adequately represent the interests identified above and (2) are willing
to negotiate in good faith to reach a consensus on the proposed rule, as shown by the following: 

                  D.     There is a reasonable likelihood that a committee will reach a consensus on the proposed rule
within a fixed period of time because:

                       E.     The use of this procedure will not unreasonably delay formal rulemaking and issuance of a final rule 
because:

                         F.     [Optional for response by Petitioner]  The State Real Estate Commission should commit its
resources, including technical assistance, to such a committee because:

                   G.     [Optional for response by Petitioner]  The State Real Estate Commission should, to the maximum
extent possible consistent with its legal obligations, use a consensus of such a committee as the basis for a rule to be
adopted under the Administrative Procedure Act because:

        6.           The following persons will be significantly affected by any rule which might result from the negotiated 
rulemaking procedure which is the subject of this Petition [identify such persons by name and address where possible]:
          

       7.            The following persons may be willing and qualified to represent the interests that will be significantly
affected by any rule which might result from the negotiated rulemaking procedure which is the subject of this Petition
[identify such persons by name and address where possible]:
 
          

        8.            Petitioner offers the following additional information for use by the Commission in consideration of 
this request [if any]:          
 
              

       9.            Petitioner will submit, within 5 days from submitting this form,  the following documents in support of
 this request [list all documents to be submitted]:
          

Submission of this Petition for Negotiated Rulemaking verifies that all statements and information provided herein are true and correct and may be used as necessary by the Nebraska Real Estate Commission if furtherance of assuring compliance with the laws it regulates.

 Dated                  

            
List Petitioner's name             

            
List Petitioner's full mailing address             

            
List Petitioner's telephone number