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of <br />0" <br />oath. <br />(You need not give an oath if you object. Iyjo;w object togl ivg <br />an oat}, jtlease no i,� y the hearing officer orxeavtag befog sig ting below.) <br />1, the undersigned, hereby solemnly swear that the testimony I give at this pto- <br />eeedtng,wifl be the tru h, the whole ttuth and nogg but the tf-uth: <br />PRINT NAME: SIGN NAME: <br />6 A <br />irJ <br />s. <br />3. <br />4. <br />5. <br />G. <br />7. <br />8. <br />9. <br />10. <br />Ptepared by: The City of Lakewood Law Department,12650 Detroit Ave., Lakewood, Ohio 44107 <br />FOR CITY U515 ONLY <br />Lakewood Admm'strative Procedure: 0 ABR,/BBS C1 Citizens ,Ad-,isoq 0 Civil. Svc. El Daagerous Dog CJ Income <br />Tax Appeals EJ Loan Approval El Nuisance Abatement Appeals 1) Parking �.nlzzg.:� h n.oning Appeals 0 other: <br />Date of Proceeding: I k C4 6=10. %041 I&A <br />