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2. City of Cohoes Traffic Commission
   Request for a Traffic Commission Agenda Item
4. APPLICANT INFORMATION
6. NAME:*
8. ADDRESS:*
10. CITY:*
11. STATE:*
12. POSTAL CODE:*
14. MAIN / CELL PHONE NUMBER:*
15. WORK PHONE NUMBER:
16. EMAIL ADDRESS:
18. AGENDA ITEM REQUEST INFORMATION
20. SPECIFIC ITEM OF REQUEST*
22. LOCATION OF REQUEST*
24. NARRATIVE EXPLAINING REQUEST*
26. ATTACHMENTS INCLUDED
28. PHOTOGRAPHS
29. PETITIONS
30. LETTERS
31. OTHERS
33. The undersigned has read the foregoing document and knows the contents thereof and that the facts set forth therein are true to the best of his/her knowledge, information and belief.
35. 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, 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, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Electronic Signature
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field