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 />Todays Date: Lt? 2-V <br />Name: P/r) ( S <br />Mailing Address: SGv ~Y C%fc/~ J <br />Agenda Item/Application Name: <br />Please circle one of the options below <br />Speaking in favor Speaking Against Neutral (neither in favor or opposition) <br />Do not wish to speak but w ufcHik o be notified of the Hearings Official decision <br />Please return completed form to City of Eugene staff. <br />