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REQUEST FOR HONORARY STREET DESIGNATION <br />Name of Person Making Request: <br />Mailing Address: <br />Contact Person's Phone Number(s): Daytime: <br />Evening: <br />Contact Person's Email Address: <br />Name of Individual or Group Proposed: <br />Date of Death (If Applicable): <br />Indicate Street for Designation Request: <br />I hereby declare that the information contained herein is true and correct to the best of my belief and <br />knowledge. <br />Sponsor <br />Printed Name <br />Date <br />