Free Certification Page for Agencies Exempt from the APA - Wyoming

Certification Page Agencies Exempt from the APA

1. General Information
a. Agency/Board Name See attached list for references b. Agency/Board Address e. Name of Contact Person g. Contact Email Address i. Program(s) See attached list for references c. Agency/Board City f. Contact Telephone Number h. Adoption Date d. Agency/Board Zip Code

2. Rule Type and Information
a. Choose all that apply: New Rules* Amended Rules Repealed Rules
* "New" rules means the first set of regular rules to be promulgated by the Agency after the Legislature adopted a new statutory provision or significantly amended an existing statute.

If "New," provide the Enrolled Act number and year enacted: b. Provide the Chapter Number and Short Title of Each Chapter being Created/Amended/Repealed (if more than 3 chapters are being created/amended/repealed, please
use the Additional Rule Information form and attach it to this certification)

Chapter Number: Chapter Number: Chapter Number:

Short Title: Short Title: Short Title:

c. The authority to promulgate these rules is provided pursuant to W.S. d. The attached rule(s) pertain to:

3. Agency/Board Certification
The undersigned certifies that: 1. The foregoing information is correct; 2. The attached rules are a true and correct copy; and I am the Agency head of _________________________________________________________________; or 3. I am the chairperson of the _______________________________________________________________.
(enter name of board)

Signature of Authorized Individual Printed Name of Signatory Signatory Title Date of Signature



Distribution List: Secretary of State: Hard copy of certification page; PDF copy of final rules sent to [email protected]