i v) <br />Request to Speak at Hearings Official Public.Hearing / <br />The purpose of this form is to make sure that people wishing to testify have an opportunity to do so, as well as to <br />make sure hat the names and mailing addresses of those testifying are correct and become part of the record. Any- <br />one wishing to testify is requested to fill out this form. People speaking at the hearing as well as those submitting <br />written testimony will be notified of the Hearings Official decision by mail. <br />PLEASE PRINT CLEARLY <br />TodaysDate: 1h I is <br />Name: I~~ogA C,1~D t <br />Mailing Address: ~~f~y~G~ ~n~,~Bp~✓ ~~g ?j )i~ ,v~~e <br />Agenda Item/Application Name: <br /> <br />-rteAv, <br />Please circle a of the options below <br />Speaking in fa r Speaking Against Neutral (neither in favor or opposition) <br />Do not wish to speak but would like to be notified of the Hearings Official decision <br />Please return completed form to City of Eugene staff. <br />