Request for Issuance Proclamation Form

Request for Issuance of Proclamation Online Form

*Requesting Party:
*Address:
Home Phone:
Work Phone:
*Email:
Name of Organization:

*Select One:	I will pick up proclamation. Please advise when ready. Please mail proclamation to above address.

*Suggested "NAME" of day, week or month to be proclaimed:

*Date(s)to be proclaimed:

*Short statement ( not more than 100 words and not more than four "WHEREAS" paragraphs ) describing the reason for the proclamation ( i.e. anniversary, commendable public service, etc. ) This statement, if approved, will be included in the proclamation.: