6 7 8 W e s t 18 t h S t r e e t, M e r c e d, C A 9 5 3 4 0
C I T Y O F M E R C E D
REQUEST FOR DISPLAY OF COMMEMORATIVE FLAG FORM
NAME/ORGANIZATION:________________________
TODAY’S DATE:______________
REASON FOR REQUEST FOR COMMEMORATIVE FLAG:_____________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
CITY FACILITY REQUESTED:_____________________
TIMEFRAME FOR DISPLAY OF FLAG:____________________________