Request For A Ceremonial Document Form From The Honorable James F. Kenney Mayor, City Of Philadelphia

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REQUEST for
Date Rcvd. In Office __________
CEREMONIAL DOCUMENT from
THE HONORABLE JAMES F. KENNEY
MAYOR, CITY OF PHILADELPHIA
Carefully read the following Guidelines before completing the request form.
All requests go through an internal review and approval process.
Requests for ceremonial documents are limited to one per individual or organization per year.
Submitting a draft of the document requested will expedite the process.
All requests should be received AT LEAST THREE WEEKS BEFORE THE DOCUMENT IS
NEEDED. DOCUMENT REQUESTS RECEIVED AFTER THIS MAY NOT BE APPROVED.
Send the request to:
Lorraine Szybowski
Office of the City Representative
th
1515 Arch Street, 12
Floor
Philadelphia, PA 19102
Phone: (215) 683-2060
Fax: (215) 683-2099
Email: Lorraine.Szybowski@phila.gov
There should be only one contact person per request.
PLEASE PRINT LEGIBLY AFTER READING THE GUIDELINES ABOVE.
Name of Contact: _____________________________________________________________
Telephone # ___________________________
Fax # ____________________________
E-mail Address _____________________________________________________________
Person/Organization Recognized ______________________________________________
Affiliation with Person/Organization
_______________________________________
Event/Occasion _____________________________________________________________
Does the person reside or is the organization located in Philadelphia? __________
Will the event or occasion be held in Philadelphia? __________
Today’s Date _________________
Date of Event/Occasion _________________
Printing deadline (If applicable) _________________
Highlights of Person/Organization Recognized: PLEASE ATTACH a biographical sketch
of the individual including his/her involvement in the community, or a description of the
organization and how it impacts the community.
*For Official Use Only:
Document Approved ________
Document Denied ________
Tribute___
Citation____ Proc____
Letter___
Comments____________________________________________________________
ALL DOCUMENTS MUST BE PICKED UP. NO DOCUMENTS CAN BE MAILED.
When your document is completed, our office will call your Contact Person for pick-up. If
you would like someone other than your Contact to pick up the document, please list their
name and number below.
Name __________________________________
Telephone # ____________________

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