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CITY OF TUSTIN
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
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AITEM NO. ❑ PUBLIC INPUT ❑
............................... ..................................................................................... ::..........................................................................................................................
IN FAVOR ❑ OR OPPOSITION ❑"fO MATTER? TODAY'S DATE A I-
NAME`:_ t: + 1,J 0 ORGANIZATION
_ (if applicable)
ZIP CODE %
HOME/WORK PHONE NO. E-MAIL ADDRESS
(please indicate one)
CITY OF TUSTIN
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
............................... .................... ................... ................ ................ I......... ........................................................................................................................
AGENDA ITEM NO dc-- PUBLIC INPUT ❑
................................................................................................................................................................................................................................................
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE �( � / ,)
NAME ORGANIZATION
nA (if applicable)
HOMEWORK A DR S CITY/ZIP CODE
HOME/WORK PHONE NO.
(please indicate one)
E-MAIL ADDRESS