NOTICE OF PROPOSED DELEGATION AGREEMENT
A.R.S. § 41-1081(B)
1.	Agency initiating the agreement:
Answer
2. 	The political subdivision to which functions, powers, or duties are proposed to be delegated:
Name of political subdivision
3. 	Contact information:
Name:	First and Last Name
Title:	Title
Division:	Agency Division	
Address:	Street address, city, state, and zip code
Telephone:	Include area code, (xxx) xxx-xxxx
Fax:	(if applicable), include area code, (xxx) xxx-xxxx 
Email:	Email address
Website:	Website address
4.	Summary of agreement including subjects and issues:
Summary of agreement
5.	An electronic copy of this agreement can be viewed at:
Website address:
6.	A paper copy of this agreement can be obtained at:
Physical address:
Copy or other fees:
7. 	Schedule of public hearings:
Date:  mm/dd/yy
Time:  0:00
Physical Location:  Address
Google Meet/Skype/Zoom:  web address