Town Hall » Office of the Mayor » Proclamation/Certificate Request Form

Proclamation/Certificate Request Form

This form has been created to expedite your request for a proclamation or certificate. The Mayor is hopeful of accommodating every request. Your completion of this form will help the Mayor in that task.

Please provide the following information:

Purpose of Proclamation(i.e. retirement, business grand opening/ribbon cutting, anniversary, special recognition, etc.)

Proclamation DateDate of Proclamation/Event Presentation:

Proclamation LocationLocation/Address of Presentation:

Phone NumberOn-site Telephone Number/Cell number

Date NeededDate Proclamation Needed:

DeliveryDelivery of Proclamation/certificate:

Please mail
Pickup at Town Hall

Presence Requested Mayor's Presence Requested at Presentation: (If yes, please refer to the Mayor's Event Request Form and submit with this request)

Yes
No

Recipient Contact InformationFull name, address, telephone numbers, and e-mail address of person(s) or organization receiving the proclamation or certificate:

Requester Contact InformationFull name, address, telephone numbers, e-mail address of person(s) or organization, and relationship to recipient(s) of the person requesting the proclamation or certificate:

Proclamation PurposeBriefly describe the purpose of the proclamation or certificate or the message that you would like to convey:

Due to the volume of requests received and the time needed to prepare proclamations or certificates, all requests must be submitted 6 weeks in advance and include all background information and other supporting materials necessary for the proclamation or certificate to be written.

Submitted byFull Name:

Date Submitted

Submitter Email Address

Submitter Phone NumberCell/Primary Phone Number:

The Office of the Mayor will respond to this request in writing. Until written confirmation is received, all requests are pending and should not be referenced in invitations or announcements printed or otherwise. Please allow 21 days for processing.