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PLANNING NY COMMISSIONSIGN-UP <br /> PRINT CLEARLY ' 'I , <br /> Name: Civ?c{-1 n Date: S f-7 J2d2I <br /> 1p� �of <br /> Representing: I vllkyluitu 9 J b11"1-ei.. tf /h Dv\ <br /> Mailing Address: \0 % ° V 1co a; . <br /> Phone Number(s): 2 11—(OS (Business) (Residence) <br /> Name of Applicant or Agenda Item #: <br /> When do you want to testify? (You may only select one): Ll Abeginning of Hearing <br /> t When Agenda Item is called <br /> Are you submitting written testimony at the hearing? Yes [9/ No❑ <br /> � : ubmit this form and written testimony to staff member. <br /> Bre su is ct - Limit testimony to new information - Speak directly into the microphone. <br />