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cm mF <br />LAK E <br />1c;I <br />Please, PRINT. <br />Name: <br />Address: <br />Agenda Item/Subject: <br />Representing <br />Company/Individual: <br />City of Lake Elmo <br />REQUEST To APPEAR <br />Before the <br />City Council or Planning Commission <br />C— o /1 S r <br />� fu 73 3Z/lJ s L A <br />I / I e--ln1b l-I'L.. <br />Note: Please, complete this form you may be recognized at the appropriate time. You are under no obligation to speak if you <br />change your mind during the meeting. Please, state your full name and address for the record. Thank you. <br />