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2. Name and Request for Public Hearing:*
   This is the applicant's name and reason for the public hearing. Both can be found on the public hearing notice.
4. Date of the Public Hearing
   Date of the Public Hearing
   The date can be found on the public hearing notice.
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
14. Comments
    Your comments will be read into the record. If you need to submit additional information, you can email documents to iclark@cityofjerome.org.
16. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, and 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature.

    1. I agree.
18. Phone Number
19. Email Address
21. Electronic Signature*
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

* indicates a required field