4.1164—Contents of application.
Any person filing an application for review shall incorporate in that application regarding each claim for relief—
(a)
A statement of facts entitling that person to administrative relief;
(b)
A request for specific relief;
(c)
A copy of any notice or order sought to be reviewed;
(d)
A statement as to whether the person requests or waives the opportunity for an evidentiary hearing; and
(e)
Any other relevant information.