Form Center

2. Requester's Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Fax Number
14. Agency/Organization (if applicable)
16. Proclamation Type
    -- Select One --RecognitionCongratulationsAwardRetirementOther
17. Citation Type
    -- Select One --BirthdaysDeaths (Exclude timeframe)EventVolunteerismAnniversaryOther
19. Purpose of Proclamation/Citation (please provide as much detail about the individual/occasion as possible)*
21. Mayor's Presence Requested at Presentation

    1. Yes
    2. No
23. Honoree (individual, group, company or organization)
25. Event Name (if applicable)
27. Date of Event (if applicable)
    Date of Event (if applicable)
29. Location of Event (if applicable)
31. Date Required (date by which proclamation must be received)
    Date Required (date by which proclamation must be received)

    At least 4 weeks from request date and no more than 90 days from request date.

33. Proclamation Language or Greeting (1000 characters max)*

    Proclamations can be picked up at the Town Manager's Office, 800 Bloomfield Avenue, Bloomfield, CT. If you require assistance, please call the Town Manager’s Office at 860-769-3504.

35. File Upload or Attachments
Leave This Blank:


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

    This field is not part of the form submission.

39. Submit

* indicates a required field