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2. Organization Name*
3. Your Name*
5. Address
7. City
8. State
9. Zip Code
11. Phone*
12. Email*
14. Name or Title of Proclamation/Certificate Requested*
16. Commissioner Sponsor*
    -- Select One --Mayor Nancy Sikes-KlineVice Mayor Roxanne HorvathCommissioner Barbara BlonderCommissioner Cynthia GarrisCommissioner Jim Springfield

    Please choose the Commissioner that has agreed to sponsor your proclamation. See the City Commission page for contact information to obtain a Commissioner-Sponsor.

18. Purpose of Proclamation*

    1. Arts and Cultural Celebration
    2. Charitable Fundraising Campaign
    3. Civic Proclamation
    4. Public Awareness Campaign
    5. Special Honor for Individual or Organization
    6. Other
19. Upload a Draft of Your Proposed Proclamation
21. Dates of Proclamation*
    Dates of Proclamation Start Date

    —

    Dates of Proclamation End Date
22. Details of Dates*
24. Description of Your Organization*
    Please include a brief description and any other relevant information related to your request. You may also attach additional information/documentation to this application.
26. Has the same or a similar proclamation been requested in past years?

    1. Yes

    1. No
27. If yes, when?
29. You must provide the draft wording. The personal information on this form is collected under the authority of the Municipal Act. The information is used for the purpose of processing the application for the proclamation. Questions about the collection of this information can be made to the City Clerk at 904-825-1007.
31. 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.
33. Electronic Signature
35. If you choose to print and complete this form, return it to:
    City of St. Augustine
    City Clerk's Office
    75 King Street
    St. Augustine, FL 32084
    Phone: 904-825-1007
    Fax: 904-825-1008
    Email City Clerk
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field