PUBIC  PARTICIPATION  FORM -/
									   	FOR
				    	KERR  COUNTY  COMMISSIONERS'  COURT	    	!/
	 	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)  you  wish  to
	 	address  are discussed.
	 	If you  are  handing  out  any  material  or documents  to  the  Court,  please  make  sure
	 	you  have  one extra  copy for the  Clerk to  ensure  that one  is  put  into the  record.
			 	Name:	     	i    	.		♦   	dill    	Pt:'
			 	Address:	 	Rid    	aicwi
						 	k AA hbO rk )
			 	Telephone:     	(    	O6j   	'17	 	4 .
				Place  of Employment:  &6t  h,			  	L	 	rl  (
										     	�h		  	e  G    	t t4O  ( a   	_r'
				Employment Telephone:AROL)  `� —  5‘5 U
	 	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:
					.. P e t  gal    	pc,  b1  t..	     	merle/
	 	Which Agenda  Item  (or  Items) do you  wish to  address:
	 	In general,  are you for or against such  Age  da  Ite    	(or  Items)?  For	  	Against
									    	Sign   	ure
	  	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  your  name  and  who /what  you  represent
	  	clearly for the  court  reporter to  accurately  record  who  you  are.
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