Form for Notification of Objection to Annexation, Request for Arbitration Panel, & Provision of Contact Information
I. Notice
As provided by O.C.G.A. Section 36-36-110-119, et seq., We the undersigned, as duly appointed representatives of TYPE COUNTY NAME HERE County, hereby notify the Georgia Department of Community Affairs that we have, by majority vote, notified the City of TYPE CITY NAME HERE of an objection to an annexation of land, and do hereby request an Arbitration Panel. Attach the full text of the objection notification required by the statute as well as all other materials required by DCA Rule 110-12-8-.03(1)(a). We understand and acknowledge that it shall be the responsibility of the Parties to the Annexation dispute to: Provide proposed “strikes” from the panel as quickly as practicable, within the timeframe it provides to the local governments when it requests strikes; Provide for the administration and reimbursement of expenses of the arbitration panel once it has been appointed by the Department; Refrain from any ex parte communication with the panelists; Notify the Department of any panelist’s withdrawal, and request a new panelist be provided, in writing; and, Notify the Department in writing, as soon as practicable, when the panel proceedings are terminated for any reason.
II. Legal Description- Land Lot, District, Section, Block and Lot(s) / Address of subject property:
Type Legal Description of Annexed Property Here
III. Contact Information
Contact Name & Title	County: County Contact Name	City: City Contact Name	Owner: Owner Contact Name
Street & Postal Address	County Contact Address	City Contact Address	Owner Contact Address
Phone Email	County Contact Phone # county contact email addr	City Contact Phone # city contact email addr	Owner Contact Phone # owner contact email addr
Send this form to: Georgia Department of Community Affairs Office of Planning (Annexation Arbitration) 60 Executive Park South, NE Atlanta, Georgia 30329 Page 1 of 1 HB2A Email: planning@dca.ga.gov