Reason for appearing before the Commissioners' Court:*

Written Testimony Only General Public Testimony

Resource Witness

I am appearing before this body to testify regarding: *

My position on the above matter is: *

For Against

Neutral

In so appearing, I hereby make the following statements:*

My name is: *

Home Address:*

Home Phone:*

Business Address:

Business Phone:

In appearing before the Commissioners' Court, I represent:

myself, and my occupation, profession or business:

Name of Business:

AND/OR

the following persons, firms, corporations, classes or groups:

Persons, firms, corporations, classes or groups:

Whose address is:

I do solemnly swear or affirm that the above statements by me are true and accurate, and that I have listed all persons, firms, corporations, classes or groups which I represent in reference to the matters on which I am appearing and that the testimony I am about to give before the Midland County Commissioners’ Court will be the truth, the whole truth, and nothing but the truth.

Date: *

Signature:*

A person who makes a false statement under oath is subject to prosecution under Section 37.02, Penal Code.