S:\CityClerk\FORMS AND INFORMATION FOR STAFF USE\Written Petition Form - 2016.doc
CITY COUNCIL 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:______________________
I, ________________________________________, am hereby requesting to be placed on the Santa Clara City Council Agenda for the following purpose:
___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 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:
NAME: ________________________________________
ADDRESS: ____________________________________
Street
______________________________________________
City Zip Code
TELEPHONE:* _________________________________
Optional
DATE: ________________________________________
*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.