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EVERETT CITY COUNCIL <br /> SPEAKERS REQUEST MEET <br /> NO1'.16: PLEASE STATE YOUR NAME AN)ADDRESS BEFORE YOU-BEGIN <br /> PLEASE PRINT: <br /> DATE: (o / 7/q <br /> NAME: TYA4 - 1±711-1— <br /> ADDRESS: <br /> 1 r-rADDRESS: 6e (1- 1S77 ?/2- s� <br /> CITY/STATE: s-16.(o <br /> I wish to. speak to the Everett City Council under "Citizens Comments" or <br /> "Audience Comments" regarding a topic that is not on the agenda. Briefly describe <br /> your topic below: <br /> I would like to comment on Agenda item # on today's agenda. You will be <br /> given an opportunity to speak when that item is called. <br /> Each citizen is asked to limit comments to 3 minutes. The purpose of this practice is to allow all <br /> citizens a. fair opportunity to speak If you wish to give a longer presentation, please contact the <br /> Council Office at (425) 257-8703, before you speak, either in writing, or by phone, so that other <br /> arrangements may be made to allow you the time you may need. Please return this form once <br /> completed to the Council Administrator before the meeting begins. <br /> Project of Activity Title: Date: <br /> Meeting I Activity Location: - <br /> Everett City Council meeting 3002 Wetmore Avenue, Everett,Washington,98201 <br /> Name(PIease Print): Gender: <br /> Male Female <br /> General Ethnic Identification Category (please check one) <br /> Caucasian Hispanic American American Indian I Alaskan Native <br /> African American Asian/Pacific Island Other <br /> Color: -National Origin: <br /> "CIVIL RIGHTS ACT OF 1964, 111LE VI STATEMENT TO THE PUBLIC: The City of Everett hereby gives public notice that it is policy of <br /> the City to assurefull compliance with Title VI of the Civil Rights Act of 1964,the Civil Rights Restoration Act of 1987,and related statutes <br /> and regudations in all its programs and activities. Persons wishing information regarding the City's Title VI compliance <br /> may call 425-237-8703, Title VI Specialist for the City CowzciL" <br />