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PUBLIC PARTICIPATION FORM
FOR
KERR COUNTY COMMISSIONERS' COURT
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Instructions: Fill out all appropriate blanks. Please print or write legibly. Present to the County
Clerk prior to the time that the Agenda Item (or Items) youtwish to address are discussed.
Name: r m ~~~ L laa ~ /~-
Address: _~ ~ ~o Hov-i a:u ~ f~-
Telephone: ~' ~ ~ ` 7r~ ~"
Place of Employment: r ~~ isC ~-
Employment Telephone:
Do you represent any particular group or organization? Yes ^ No
If you represent a group or organization, please state the name, address and telephone number of
such group or organization.
Which agenda Item (or Items) do you wish to address?
In general, are you for or against such Agenda Item (or Items)? For ^ Against ^
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Signature
NOTE: This Public Participation Form must be presented to the County Clerk prior to the
time the agenda item(s) are discussed.
Once you reach the podium please state vour name and whohvhat you
represent clearly for the court reporter to accurately record who you are.