Constituent Services Guide - The City Of Newark, New Jersey

PROCLAMATION/COMMENDAT
ION DETAILS
CONTACT INFORMATION
PROCLAMATION/COMMENDATION REQUEST FORM
DATE: ____/_____/2009 SUBMITTED BY: ______________________
€ INDIVIDUAL € GROUP € BUSINESS
AWARDEE’S NAME:
ADDRESS :
CONTACT EMAIL:
CONTACT NUMBER: DATE NEEDED BY:
PROCLAMATION/COMMENDATION TO BE PRESENTED AT:
OTHER INFO:
FOR
INTERNAL
USE ONLY
Contact
information
for
individual
making
this
request
DATE
REVIEWED:
NOTES:
Please attach any supporting documentation!
NAME:
TITLE:
EXTENSION:
EMAIL:
€ DECLINED €
APPROVED
€ OTHER:____________________
€
DATE COMPLETED:
Director of Constituent Affairs
Signature for Authorization:
57