REQUEST TO SPEAK AT PUBLIC HEARING [41 P <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 make 'sure that <br />the names and mailing addresses of those testifying are correct and become part of the record. Anyone wishing to testify is re- <br />quested to fill out this form. People speaking at the hearing as well as those submitting written testimony will be notified of the <br />decision by mail. <br />PLEASE PRINT CLEARLY <br />Today's Date: March 7, 2017 <br />Name: 8 (9 r'P JV) <br />Mailing Address: <br />1 13 % 41der- Sf ~ra je re l .D R V/7yo' <br />Agenda Item/Application Name: UGB Adoption Package <br />PLEASE CHECK ONE OF THE BOXES BELOW <br />❑ Speaking in favor <br />Against/Opposed <br />❑ Neutral (neither in favor or opposed) <br />❑ Do not wish to speak but would like to be notified of the decision <br />Please return completed form to City of Eugene staff. <br />