Public Participation Form
Citizen Name:
Citizen Address:
_________________________________________________________________
Contact Number(s):
Description of Concern
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What is the date of the Meeting youd like to be recognized on?
Have you contacted the responsible department prior to this request to address the City Council? Yes / No
If you answered ‘yes’, please list the name of the person you spoke with, and the date you spoke with them
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_________________________________ __________________________
Citizen Signature Date
_____________________________________ _______________________
City Clerk’s Official/Employee Stamp Date Received
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Office Use Only Was the request filed before 12:00 p.m. the Wednesday preceding the meeting? Are there any maps, sketches, or drawings filed with the participation request?
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