Annexation Arbiter Availability
Attestation
I, TYPE PANELIST'S NAME HERE, having received the statutorily mandated training, do hereby attest to my availability and willingness to serve (subject to actual scheduling availability) on an Annexation Arbitration Panel, between the dates of: Type Date of Notice of Objection to Annexation Here and Type Date Falling 85 Calendar Days After Notice of Objection Here I understand that: I will be with the other panelists to schedule one or more meeting(s) at a time and place mutually satisfactory to the parties to the arbitration dispute and the other arbitration panelists, and that I must not discuss the arbitration with any other party, including the parties to the dispute; I must contact the other panelists and the Department of Community Affairs as far in advance as possible if I am ever unable to serve on the panel after being scheduled; and A decision shall generally be rendered (by the panel) no later than the 60th calendar day following the panel’s appointment [any process extensions or postponements must comply with DCA Rule 110-12-8-.03(9)], and that the panel will be discharged on the tenth day after rendering its decision, provided however that if the panel’s decision is appealed to a court of law, the panel may be reconvened as provided by the statute.
II. Signature & Date
Signed:	Date:
III. Contact Information
By signing above I also acknowledge receipt of the “Consent to Participate in Georgia Department of Community Affairs Arbitration Panel” Form provided to me and understand that I must fill it out and return it to the Department for its records in order to qualify for Georgia Tort Claims Act (O.C.G.A. 50-21-22 (7) liability immunity.
Send this form to: Georgia Department of Community Affairs Office of Planning (Annexation Arbitration) 60 Executive Park South, NE Atlanta, Georgia 30329 Email: planning@dca.ga.gov

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