City of
Santa Clara
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CITY COUNC IL WRITTEN PETITION
Please provide the information requested below. When complete, please submit to the City Clerk's Office, 1500 Warburton Avenue, Santa Clara, CA 95050. } / Date: IJ..?)o #
I, f ~ ?~Pr , am hereby requesting t: be placed on the Santa Clara City Council Agenda for the following purpose:
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t d t\:1Alr.+-- Eo IL -mu ,&eA-M E...Nn ~ I 1 Jf\slffid----o..,J (Af.JL :r:J.,., a I understand that it is important that I attend the meeting in the event there are any questions the Council wishes to ask me.
Signed: ~k
NAME: f ~ ~£_;~
r\ <:J Q( ./1/,,Utl. ~ ADDRESS : _____:::d-::..._=---:....Df - - ~....__,._u.......:... _ _.~.....;...._-- Street
L-Utl-A- 150 5" I
City Zip Code
TELEPHONE:* VD~ Y)-3 --J lf 'f 7
Optional
DATE: IJ-./2:~ }:>-rt= l I
*NOTE: This is a public document. If your telephone number is unlisted or if you do not want it to be public, please provide an alternate number where you can be reached.
S \C1tyClerk\FORMS AND INFORMATIO N FOR STAFF USE\Written Petition Form - 2016 doc