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Proclamation/Certificate Request Form

2. Sharon Weston Broome
   Mayor-President of East Baton Rouge

5. 

10. City of Baton Rouge Parish of East Baton Rouge honors many local and national organizations, events, and individuals for outstanding humanitarian efforts by presenting them with an official proclamation or certificate from the Mayor-President of East Baton Rouge. The Mayor will review all requests and decide which acknowledgment to issue.

12. Proclamations are only used for:
    Certificate of Appreciation<br> Certificate of Celebration<br> Certificate of Commendation<br> Honorary Mayor's Certificate<br> Proclamation<br> Resolution of Condolence

    Certificate of Appreciation
    Certificate of Celebration
    Certificate of Commendation
    Honorary Mayor's Certificate
    Proclamation
    Resolution of Condolence

14. An application must be completed and submitted a minimum of 7 business days in advance of the requested event online.
    
    Upon approval the proclamation and or certificate can be picked up on Tuesday or Thursday only from the Mayor's Office, 222 Saint Louis Street, 3rd Floor, during business hours (8:30 am - 5:00 pm).
    
    One proclamation allowed per event.
    
    For more information regarding the issuance of proclamations or certificates contact Mandy Green at 225-389-3100.

16. Recipient Information

18. First Name*

19. Middle Initial*

20. Last Name*

22. Title*

23. Display Name on Certificate as*

25. Proclaiming Organization Information

27. Name of Organization*

28. Event Date*
    Event Date

30. Reason for Proclamation/Certificate*

32. Requestors Information

34. First Name

35. Last Name

37. Contact Phone

38. Fax Number

40. Contact Email

41. Select a Tuesday or Thursday for Pick Up*
    Select a Tuesday or Thursday for Pick Up

43. Additional Comments

45. (Upload Documents/Pictures/Video) txt, pdf, doc, docx, gif, jpg, png, avi, mov, mp3, mp4, wav files only; 14 MB max

47. 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.
49. Electronic Signature

Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

* indicates a required field