HomeMy WebLinkAboutSAMPIGE, SRINIVASCITY 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 maybe used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
AGENDA ITEM NO. ❑ PUBLIC INPUT V
IN FAVOR ❑ OR OPPOSITION 16TO MATTER?
NAME Srinivas Sampige
HOMEr'1NORK ADDRESS
HOME/WORK PHONE NO.
(please indicate one)
11/19
MEETING DATE
ORGANIZATION
(if applicable)
CITY,ZIP CODE
E-MAIL ADDRESS