Petition for Square Dedication

Petition for Square Dedication
Date of petition:

MonthDayYear
I hereby request that the intersection of...
(First Street Name)
and...
(Second Street Name)
be designated...
(Military rank–if any–and full name of person to be honored)
By submitting this form, I acknowledge that I have read the criteria required for the dedication of a square and believe that this proposal meets those criteria. I have attached supporting documentation to support this claim. I understand that the Veterans' Commission on Monuments, Memorials, and Dedications will review this request and make an objective determination regarding its merits.
Name of person making the request:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone number:*

Area CodePhone Number
Email address:*
Name of alternate contact person (if any):

First NameLast Name
Alternate contact phone number (if any):

Area CodePhone Number
Alternate contact email address (if any):
Supporting documentation (discharge papers, awards, articles, etc.):

Upload a File
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