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EVERETT CITY COUNCIL <br /> SPEAKERS REQUEST SHT <br /> NOTE: PLEASE STATE YOUR NAME AND ADDRESS BEFORE YOU BEGIN <br /> PLEASE PRINT: <br /> DATE: 1 ?- t2, <br /> • <br /> NAME: Aid01L <br /> ADDRESS: 2 33, 6 27 PkCQ N <br /> CITY/STATE: Evt frt WA %$ z0 <br /> • <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 /> it I) CB I0.II- 5 ? <br /> • <br /> 0 h7-1-D1) <br /> I would like to comment o agenda. You will be <br /> given an opportunity to spe <br /> Each citizen is asked to limit c is practice is to allow all <br /> citizens a fair opportunity•to s ration, please contact the <br /> Council Office at (425) 257-87 by phone, so that other <br /> arrangements may be made ti ge return this form once . <br /> completed to the Council Admi <br /> • <br /> Project of Activity Title: Date: <br /> Meeting/Activity Location: • <br /> Everett City Council meeting 3002 Wetmore Avenue, Everett,Washington,98201 <br /> Name(Please Print): Gender: <br /> OMale DFemale <br /> General Ethnic Identification Category (please check one) <br /> ❑Caucasian ❑Hispanic American ❑American Indian/Alaskan Native <br /> ❑African American ❑Asian/Pacific Island ❑Other <br /> Color: National Origin: <br /> "CIVIL RIGHTS ACT OF 1964, TITLE VI STATEMENT TO THE PUBLIC: The City of Everett hereby gives public notice that it is policy of <br /> the City to assure full compliance with Title VI of the Civil Rights Act of 1964, the Civil Rights Restoration Act of 1987, and related statutes <br /> and regulations in all its programs and activities. Persons wishing information regarding the City's Title VI compliance•may call 425-257- <br /> 8703, Title VI Specialist for the City Council." <br />