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2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Home Phone Number
14. Cell Phone Number
16. Email Address
18. Do you represent a group or organization?
    If yes, please state the name, address, and telephone number of such group or organization.
20. Which agenda item (or items) do you wish to address?
22. In general, are you for or against such agenda item (or items)

    1. For
    2. Against

    Note: This Public Participation Form must be submitted to the County Clerk prior to the time that the agenda item (or items) you wish to address are discussed before the Court.
24. Date and Time
    Date and Time

    Date and Time
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field