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2. First Name*
3. Last Name*
5. Mailing Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. Email Address*
14. Applying As*

    (Select One)

    1. Individual
    2. For-Profit Corporation
    3. Not-For-Profit Corporation
    4. Fictitious Name
16. Corporation/Fictitious Name
18. Upload Division of Corporations form:
    **If applying as a corporation or "Doing Business As" a Fictitious Name, Applicant must attach a copy of the Division of Corporations form showing registration is active and in good standing.
20. Written Description of Intended Use of City Seal*
22. Upload Sketch/Visual Depiction*
    **Applicant must attach a sketch or other visual depiction of the location, size, and placement of the City Seal on the intended finished product. If the City Seal will be used with other visual elements, or other text, include a description of those items as well.
24. Number of Objects Intended to Include the City Seal*
    (For example, if the use is an artist's limited print, include the number of prints).
26. Duration of the Requested Approval*
    (For example, printing on a charity calendar for the year 2021).
28. How will the requested use of the City Seal further the City's Vision Plan and the goals of livability, authenticity, vitality, and character of St. Augustine as a distinctive community*
30. Requested Use in Conjunction with City Sponsored Event or Other Government Sponsored Event*

    1. Yes
    2. No
32. If Yes, Name of Event
34. Requested Use in Conjunction with a Private Event*

    1. Yes
    2. No
36. If Yes, Describe the Public Benefit of the Event, if any
38. 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.
40. Electronic Signature*
41. Date*
    Date
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field