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Created: 05/07/07 Revised: 07/02/12 REQUEST FOR REHEARING AND DECLARATION OF MERIT (“PETITIONER”), being aggrieved by the administrative order or decision rendered by the City Council of the City of Anaheim (“City Council”) on following the hearing regarding (“hearing”), hereby requests a rehearing of such matter by the City Council Pursuant to Section 1.12.100 of the Anaheim Municipal Code on the following grounds (check applicable grounds below): 1. That the City Council has proceeded without, or in excess of, its jurisdiction; 2. That there was not a fair hearing and the petitioner was thereby deprived of any rights; 3. That there was a prejudicial abuse of discretion by the City Council within the meaning of Section 1094.5 of the Code of Civil Procedure of the State of California; That there was relevant evidence which, in the exercise of reasonable diligence, could not have been produced by the petitioner, or which was improperly excluded by the City Council at the hearing. The following is a statement of the facts showing an entitlement to the relief sought under each of the above specified grounds. (A separate statement of facts must be set forth for each of the grounds checked above. Please number each statement of facts to correspond to the numbers checked above if more than one ground for rehearing is alleged.) (If necessary, additional pages may be attached hereto by petitioner. The contents of any pages so attached shall be deemed incorporated herein by this reference.) The petitioner acknowledges that any rehearing granted by the City Council will constitute a de novo hearing, vacate the original decision, and authorize the city council to affirm, reverse or in any manner modify its original decision. I declare under penalty of perjury that the foregoing is true and correct and that I executed this declaration this day of at California. PETITIONER Name (Print) PETITIONER Signature Street Address City, State, Zip Code Contact number NOTICE TO PETITIONER: THIS REQUEST AND DECLARATION MUST BE ACCOMPANIED BY A FILING FEE IN THE AMOUNT OF SEVENTY-FIVE DOLLARS ($75.00) AND BE FILED IN THE OFFICE OF THE CITY CLERK WITHIN THE TIME SPECIFIED IN SECTION 1.12.100 OF THE ANAHEIM MUNICIPAL CODE.