the city council's rules of council file no., agenda item, or...

14
CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK, EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU THE CITY COUNCIL'S RULES OF DECORUM Will BE ENFORCED. Council File No., Agenda Item, or Case No. [2.: D{o q. 1wish to speak before the Name of City Agency, Department, Committee or Council Do you wish to provide general public comment, or to speak for or against a proposal on the agenda? ( V(for proposal ( ) Against proposal Name:f)z..•.JO L. ( ) General comments Business or OrganizationAffiliation: {'}J-0 Address: __ ''---'j?h-b'-;· street t City r State Zip Business phone: --------- CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW: Client Name: ______________________________ Phone#: _____ _ Client Address: street City State Zip Pleasallee reverse of card for important information and submit this entire card to the presiding officer or chairperson.

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Page 1: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

THE CITY COUNCIL'S RULES OF DECORUM Will BE ENFORCED.

Council File No., Agenda Item, or Case No.

[2.: D{o q . ~~

1 wish to speak before the ----c:::.(A\..!_~~U=:o:.._:_!V)+--'("-"'-f?'J~Y\.t.A,· :..:..~.oL""-:,---,----:------------­Name of City Agency, Department, Committee or Council

Do you wish to provide general public comment, or to speak for or against a proposal on the agenda? ( V(for proposal ( ) Against proposal

Name:f)z..•.JO ~ L. <;?~~ ( ) General comments

Business or OrganizationAffiliation: ~~ ~ ~![_ {'}J-0 Address: __ -~,-\ "Sb~b7<-( (,-=----<[)-'-"KM'h'ZP~~--=S_._\--1. ''---'j?h-b'-;· ""'~~~'-Ck"""· :u__,4"-"'1Q"4.·'k~··,---~---

street t City r State Zip

Business phone: --------- Representing:----------------~~-----

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW:

Client Name: ______________________________ Phone#: _____ _

Client Address: ----coo--c-------------=c---------~~-----=~-----street City State Zip

Pleasallee reverse of card for important information and submit this entire card to the presiding officer or chairperson.

Page 2: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

Date

) '

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

Name of City Agency, Departmerl't, Committee or Council

Y~~ proposal ) Against proposal

Do you wish to provide general public c9mment, or to speak fOJ or against a proposal on the agenda? (

Name: ' , l /l/' ~;,;" / i ) General comments

Business phone: _________ Representing: ----------------~=c-----

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW:

Client Name: ______________________________ Phone#: _____ _

Client Address: ---;,--;-------------;c;;;-----------c=-c-----=;;-:------street City State Zip

Please see reverse of card for imJ;lortant information and s!lbmit this entire card to the presiding officer or chairperson.

Page 3: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

THE CITY COUNCIL'S RULES OF DECORUM WiLL BE ENFORCED.

I Date

b ~ ~\( ~ ''}_,., I wish to speak before the -----cc-c---:-=-:---C"-~~="""""'--"C.A•.tl\..,..._--:-:: __ =_-::-___________ _

Name of City Agency, Department, Committee or Council

Do you wish to provide neral public comment, or to speak for or against a proposal on the agenda? (

c ~ ~ ) For proposal ) Against proposal ) General comments Name:

Business or Organization Affiliation:--------:-----------------------

Address: ----=:,-:-;-------'-----~-,0?'-'-'f'v-'--::l-"'"-_::::_ _____ -==-----=,------street City State Zip

Business phone: _________ Representing:-----------------;===,-------

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW:

Client Name: ______________________________ Phone#: _____ _

Client Address: -----,=,-------------,o;;~----------.=-:-----c;;::------street City State Zip

Page 4: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

THE CITY COUNCIL'S RULES Of DECORUM WILL BE ENfORCED.

Client Name: _____________________________ Phone#: _____ _

Client Address: ---,~-,-------------;;;co-----------,o;;-;------=------street City State Zip

Please see reverse of card for imj;lortant information and submit this entire card to the j;lresiding officer or ch<!irperson.

Page 5: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

THE CITY COUNCil'S RULES OF DECORUM WILL BE ENFORCED.

Council File No., Agenda Item, or Case No.

/2- ()~q I,.. S/1<?(26\LI I wish to speak before the ___ .:::U'--"·-'-·--'=<-'-?f=-=OJ::_;_c..UA __ <0_t.,__ _______________ _

Name of City Ag y, Department, Committee or Council

Do you wish to provide general public comment, or to speak for or against a proposal on the agenda? (~proposal L .l L,; A ~ (_ /) • r· ( ) Against proposal

Name: · 0'<!/ titCI itt -T[)i/( ~ · · 4-/a{!t/ £__. ( ) General comments

Business~ Organization Affiliation: ~' Vt01 H~ thhl uudi7 QV]

Address: :n (p f)' ' =fli]Ul~ 0 tl ~ l· ft- Ustate ~ip D I J= Business phone: :;2 13) ;2 :11 - ]-01 V Representing: flM!?f1 ~ ff:..rza.A.:( A( <:(Pc

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW: D Client Name: ____________________________ Phone#: ____ _

Client Address: ---;;:c:cc-:-------------;;,.,-.---------;;:;~------,oc:------street City State Zip

Please see reverse of card for important information and submit this entire card to the presiding officer or chairperson.

Page 6: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

THE CITY COUNCIL'S RULES OF DECORUM WILL BE ENFORCED.

Council Flle No., Agenda Item, o Case No.

Do you wish to provide general public comment, or to speak lor or against a proposal on the agenda~_::l'<fFor proposal ( ) Against proposal

Name~~~t;;e:J<!l {'--: ( ) General comments

Business or Organization Affiliation: _rv_\+-'-' t-' e"",\>-V..cl_,_o,__,,+'-S-'-"""""--'\..c,L'Obrl,_--------------------' = I Address: \ b eJ '-! ~J , f\11 A cJ"'"I ~A 13 6,c>4'-~);_c,(~'(-4Yl-~40:;;.,'1\D(;r.;t~u(2___:_---'-C~-,t;-A~-,_ _ ___:g~\__,"3,,_,c.~t(y_':J __

' Street / City ' State Zip

Business phone: 9> I "6 "z\-::1 ''if#] 11 Representing:-----------------;==:------

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW:

Client Name: ______________________________ Phone#: _____ _

Client Address: --.=:::-------------;;;;::------------c=:-----,cc------street City State Zip

Please see reverse of card for important information and submit this entire card to thEUJ_residing officer or chairperson.

Page 7: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

THE CITY COUNCIL'S RULES OF Case No.

DECORUM WILL BE ENFORCED. I J.,- 0 ? L---~~~~-n~~--~

I wish to speak before the ----:-:----:--::-~"'--"4+--'Ldi::Aa'\-"U't--lfo-:;· ~o~J~l AJFJ-'!0-4/-!.

1L.--.-,---::---------­Name of City Agency, ·1)\e;JlartmYnt, Committee or Council

Do you wish to provide general public comment, or to speak for or against a proposal on the agenda? MFor proposal 'l . ry -" . ( ) Against proposal

Name: '= £!J.Wil;i,.S l.Jn.[)efU) ( ) General comments

Business or Organization Affiliation:--------------------------------

Addmss: ____ ~~-----------~~---------~~---~~-----

Business phone: _________ Representing:-----------------==-----

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW:

Client Name: _____________________________ Phone#: _____ _

Client Address:---=-.------------=,_---------~=----=------Street City State Zip

Please see reverse of card for imJ;lortant information and submit this entire card to the presiding officer or chairJ;lerson.

Page 8: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

THE CITY COUNCil'S RULES OF Council Rle o.

1. Ao/'~d~ Item, or Case No.

DECORUM Will BE ENFORCED. rt/fh,_

I wish to speak before the ---cc--"~'-"-"::.:':.JL":'--'I-(}--=-_-c-_-::---c-:----=---::---Cf_· _ _:[c_2£b ___ q_,_TL-___ _ NameotCltYA~cy, Department, Committee or Council

Do you wish to provide general public comment, or to speak for or against a proposal on the agenda? .\><l:)For proposal ---n7/ H l.A 1:? ~ /.-"' ,, , . ~· . ( ) Against proposal Name: ~ s q I- r f) rw~ ( ) General comments

BusinessorOrganizationAffiliation: ~ ~~ Address: 332-5 {)Jf~ /Jf( ~.. CfC£1°

Street City State Zip

Business phone: 3 ( tl J?5"'CJtf1??epresenting: ---------------;==c;------

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW:

Client Name: _____________________________ Phone#: _____ _

Client Address: ---;=:::-------------;;;:;:-:-----------;=:-----c;c:------Street City State Zip

Please see reverse of card for important information and submit this entire card to the presiding officer or chairperson.

Page 9: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

Council File No., Agenda Item, or Case No. I Date

c;::, 1\SS I \L-THE CITY COUNCIL'S RULES Of DECORUM Will BE ENFORCED. J..t-0Vfi=J:

I wish to speak before the ---c-:----:--::-:---:---::---:----::----:--::?"~==-----------­Name of City Agency, Department, Committee orceoo-~di""'\

., ___ ___.~ / Do you wish to provide general public comment, or to speak for or against a proposal on the agenda? (1/fFor proposal

G ( ) Against proposal

Name: :enec/5 5u¥e2' ( l Generalcomments

Business or Organization Affiliation:-------------------------------

Address: ____ ~~-----------~~---------~~---~~-----street City State Zip

Business phone: _________ Representing:---------------'----==--:-----

0 CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CliENT INfORMATION BELOW:

Client Name: ______________________________ Phone#: _____ _

Client Address: ---:=::-c-------------;;-;;:::-----------.==-----=;,-------street City State Zip

Please see reverse of card for important information and submit this entire card to the presiding officer or chairperson.

Page 10: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE .PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

THE CITY COUNCIL'S RULES OF DECORUM WILL BE ENFORCED.

Council File No., Agenda Item, or Case No.

l2-0ic:A1 &7 I A C, ( (jJ'v-- C '\

I wish to speak before the---"'--""-'-:-:-----..LLc--:----=--'-----,,--------.,-----------­Name of City Agency, Department, Committee or Council

Do you wish to provide general public comment, or to speak for or against a proposal on the agenda? ( vf'For proposal ( ) Against proposal

Name: V\i\ 0 V\ + V\ (v(g S;>-<:, )( ( ) General comments 0 • TO \?A ( ( u 6:J"' t<d \

Business or Organization Affiliation: LA; CoJ lA.\-'\ \.) 12 r0i-·. /iF <? "-i)(\·'. \- '• eV·"'- -\-1 """ , H a 1 ,,, ,_ • Q v

Address: ::,s->o W ,\ s,\... /v-<L '£?\v~ 1 ';' 1.!:. /i I 11uv (A CA q vo { 0 Street City · State Zip

Business phone: '2--\). ') )( 1) ( Y Representing:---------------~------CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW:

Client Name: ____________________________ _ Phone#: _____ _

Client Address: ---,=::------------~~---------c=-:------c;,-,------street City State Zip

Please see reverse of card for important information and submit this entire card to the presiding officer or chairperson.

Page 11: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

Dat~

CITY OF lOS ANGElES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

\EXCEPT TOT HE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU i2-0lo0 ')(( THE CITY COUNCIL'S RULES OF Council File No., genda Item, or case No.

(2- I .:n I 1 wish to s eak be ore the p

u;;;;w;sE iJr,Eo.WJsmJ Do you wis

Client Name: ______________________________ Phone#: _____ _

Client Address: ---;c--:--------------;;o.,------------,=-----=------Street City State Zip

Please see reverse of card for important information and submit this entire card.JQJ.tll)_presidiog officer or chairperson.

Page 12: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

I f

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

THE CITY COUNCil'S RUlES OF DECORUM WILl BE ENFORCED.

Council File No,, Agenda Item, or Case No.

TkVV1-=t R\t+!I'Z-o(J;Cf{

I wish to speak before the ---c-:----:-=-:---::--:--:--::---:----;-:==~::-----------­Name of City Agency, Department, Committee o ---Do you wish to provide general public comment, or to speak for or against a proposal on the agenda? ( V)"t'Or proposal

~ j). J .: , () ( ) Against proposal Name: CX.d J! L~ w~ ( ) General comments

Business or Organization Affiliation:-------------------------------

Address: ___ ~~~-----------~~---------~~---~~-------Street City State Zip

Business phone: --------- Representing:-----------------==-----

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CliENT INFORMATION BElOW:

Client Name: _____________________________ Phone#: _____ _

Client Address: ---,=::;-------------;;;o::-----------;=:----~=------street City State Zip

Please see reverse of card for important information and submit this entire card to the presiding officer or chairperson.

Page 13: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

losJv~z~ )J I

THE CITY COUNCIL'S RULES OF DECORUM WILl BE ENFORCED.

Do you wish to provide general public comment, or to speak for or against a proposal on the agenda? (vl For proposal . C \"' ~ 1 '(-\ ( ) Against proposal

Name: -:f C\.J Y V \.A V\. (')\!V'vQ ( ) General comments

Business or Organization Affiliation:----------------------------------

Addrnss: ____ ~~------------~~----------------~~------~~---------street City State Zip

Business phone: ____________ Representing: -----------------------==c-------

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW:

Client Name:----------------------------------------- Phone#: _____ _

Client Address: ---:~-c---------------;o;,--------------;c-c-------==,----------street City State Zip

Please see reverse of card lor important information and submit this entire card to the presiding officer or chairperson.

Page 14: THE CITY COUNCIL'S RULES OF Council File No., Agenda Item, or …clkrep.lacity.org/onlinedocs/2012/12-0697_SC_05-18-12.pdf · Date ) ' CITY OF LOS ANGELES SPEAKER CARD NOTE: THIS

CITY OF LOS ANGELES SPEAKER CARD

NOTE: THIS IS A PUBLIC DOCUMENT SUBJECT TO POSTING ON THE CITY'S WEBSITE. YOU ARE NOT REQUIRED TO PROVIDE PERSONAL INFORMATION IN ORDER TO SPEAK,

EXCEPT TO THE EXTENT NECESSARY FOR THE PRESIDING OFFICER TO CALL UPON YOU

I Date V\o..y ~~I ).Q12 THE CITY COUNCIL'S RULES OF DECORUM WILL BE ENFORCJ=D.

"'

Council File No., Agenda Item, or Case No.

1'2- 0(o8.L_ 1f--:-'

Name:

Business or Organization ft. · ·

Business phone: --------- Representing:-----------------==-----

CHECK HERE IF YOU ARE A PAID SPEAKER AND PROVIDE CLIENT INFORMATION BELOW:

Client Name: _____________________________ Phone#: _____ _

Client Address: ---,;-;--,--------------=cc-----------,~-----=o------street City State Zip

Please see reverse of card for important information and submit this entire card to th~iding officer or chairperson.