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2. Village of Lombard Proclamation or Certificate Request Form

   The issuance of proclamations and certificates aims to recognize and celebrate significant achievements, milestones, and events within the Village of Lombard.

   Eligibility Criteria for Proclamation or Certificate Requests

   1. Arts and cultural celebrations taking place within the Village of Lombard.

   2. A Lombard resident celebrating a 100th birthday.

   3. A Lombard-based charity group or not-for-profit organization that has accomplished a milestone achievement.

   4. Special honors determined by the Lombard Village President.

   5. A Lombard resident or Lombard-based not-for-profit group may submit a request regarding a local recognition of a nationally established Commemorative Observance, as defined by the Library of Congress (https://www.loc.gov/law/help/commemorative-observations/index.php).

   Rules for Submission and Limitations

   1. Forms must be submitted a minimum of four weeks in advance of the date needed.

   2. Requests must be submitted using the electronic form provided. Phone, fax, email, or mail requests will not be honored.

   3. Requests must be made by a Lombard resident or Lombard-based organizations.

   4. Request must include 4-6 WHEREAS clauses and 1 THEREFORE clause to be used for proclamation; however, the Village of Lombard reserves the right to modify any proposed language.

   5. Requests may be made by seated elected officials that directly represent Lombard; however, requests within four weeks of an upcoming election in which the official is running will not be granted.

   6. All requests will be reviewed on a case-by-case basis.

   7. Only one proclamation per topic and/or organization will be issued annually.

   8. In cases where the criteria for a proclamation are not met, a certificate of recognition or congratulatory letter may be provided as an alternative.

4. Requestor Information
6. First Name*
7. Last Name*
9. Address*
10. City*
11. State*
13. Zip Code*
14. Phone Number*
16. Email Address*
18. Organization affiliation (if applicable):*
19. Organization Title/Position *
21. Request Details
23. Date Needed*
    Date Needed
24. Type of Request *

    1. Proclamation
    2. Certificate
25. Intended Use*
    -- Select One --EventOnlineEmail Published Other
27. Proposed Language*

    Please include 4-6 WHEREAS clauses and 1 THEREFORE clause

29. Has this request been issued previously?*

    1. Yes
    2. No
30. What is the desired document medium? *
    -- Select One --Digital Copy (PDF)Print Copy (Mailed)Both (PDF & Mailed)Paper Copy (Pickup at Village Hall)
32. 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 certify that the information provided above is accurate and complete to the best of your knowledge.

    1. I agree.
34. Electronic Signature
Leave This Blank:


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

    This field is not part of the form submission.

38. Submit

* indicates a required field