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REGISTRATION BEFORE COUNTY COMMITTEE <br />Committee Name: Name: ` p <br />DATE: a / Address: j 3 <br />Petition/CUP #/Subject: /jcti, �► 3W <br />O' Wish to Speak in Support ❑ Wish to Speak in Opposition <br />❑ Registering in Support ❑ Registering in Opposition ❑ Available for Information Only <br />On this occasion, are you officially representing an organization or a person other than yourself? <br />[Ifyou answered "no, " STOP; you need not complete the rest of this form. Ifyou answered `yes, " go on to the next question.] <br />Name, address and telephone number of each person or organization you are representing: <br />Comments: <br />Are you being paid for your representation or appearing incidental to your other paid duties for this person or <br />organization? ❑ YES ❑ NO [Ifyou checked "NO" to the question, STOP; you need not complete the rest <br />of this form. Ifyou checked "YES, " turn over to the next question.] <br />545-110 (1198) <br />