Respondent (name] requests that a hearing be held in this matter and

1. Objects to the [accusation] on the ground that it does not state acts or omissions on which this agency may proceed.

2. Objects to the form of the [specify, eg., accusation] on the ground that it is so indefinite and uncertain that he/she cannot identify the transaction and prepare a defense.

3. Admits that the allegations of Paragraph [number]

of the [specify, eg., accusation] are true but denies all other allegations of the [specify, eg., accusation].

4. Objects to the [specify, eg., accusation] on the ground that, under the circumstances, compliance with the requirements of [specify regulation providing basis for agency's accusation] would result in a material violation of [specify other regulation] that was enacted

by [specify other department] and that affects substantive rights.

5. Alleges by way of defense that [specify].

Respondent's mailing address is the address of counsel shown

above.