AGENCY CERTIFICATE
NOTICE OF EMERGENCY RULEMAKING (Renewal)
1.	Agency name:
Answer
2.	Chapter # and heading:
Answer
3.	Code Citation for the Chapter:
(Code Title #) A.A.C. (Code Chapter #)
4.	Article, Part, or Section Affected (as applicable)	Rulemaking Action
(In numerical order)	Answer
5.	The rules contained in this rulemaking package are true and correct as made.
6.	
	
Signature of agency chief executive officer in ink	
Type name here	
Typed name of signer*	
Type title of signer	
Title of signer	
Type date here	
Date signed	
* Please note, the signature of signer and typed name must match.