REQUEST TO BE ON CITY COUNCIL AGENDA

(Must be made no later than 12:00 noon on the Friday prior to the council meeting)

Date of Request: ___________________________

Meeting Date: ___________________________

Speaker’s Name: ___________________________

Speaker's address: __________________________ ___________________

(Street) (City)

Speaker's telephone number: (___) _______________________

PLEASE GIVE A BRIEF DESCRIPTION OF THE SUBJECT(S) YOU WISH TO ADDRESS - YOU WILL NOT BE ABLE TO DISCUSS MATTERS THAT ARE NOT LISTED ON YOUR REQUEST - YOUR REMARKS WILL BE LIMITED TO FIVE MINUTES:

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Approved / Disapproved

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Mitchell Dendy Mayor