CITY OF SUNNYVALE

COMMUNITY DEVELOPMENT DEPARTMENT

STATEMENT OF INFORMATION (SMC Sec. 19/44/020 (d)

   1.    Name and address of Person Erecting Sign:

   2.    Statement of Person Erecting Sign:  I hereby state that I have secured the permission of the owner or person in lawful possession at each address to erect the signs listed below:

                                                                                           Sign Description

          Address or Location of Political Sign   (Dimensions) 

   1.                                                                                                             

   2.                                                                                                             

   3.                                                                                                             

   4.                                                                                                             

   5.                                                                                                             

   6.                                                                                                             

   7.                                                                                                             

   8.                                                                                                             

   9.                                                                                                             

  10.                                                                                                             

  11.                                                                                                             

  12.                                                                                                             

  13.                                                                                                             

  14.                                                                                                             

  15.                                                                                                             

Dated:                                                                                                         

                                                                 Signature of Person Erecting Sign