If the Department's final determination is to refuse the requested correction or amendment in accordance with Regulation .06 of this chapter, the person in interest may file with the Department a concise statement of disagreement with the Department's refusal. This statement of disagreement shall meet all of the following requirements: The statement shall include the reasons for both of the following: The requested correction or amendment, and Disagreement with the Department's refusal to make the correction or amendment; and The statement shall contain a maximum of five pages, with a maximum size of 8-1/2 x 11 inches, and only one side of each page shall be used.