Richmond City Council
June 28, 2022

1 NOMINATION FORM FOR NAMING OR RE-NAMING

PARKS, FACILITIES OR STREETS

1. Name of Nominee:

[ ] Individual [ ] Group [ ] OrganizaƟon

2. Nominated By: Name:

Address:

City and Zip:

Telephone:

Organiza Ɵon:

3. Proposed [ ] Facility [ ] Park [ ] Street [ ] Other Current Name:

Proposed Name:

P½›ƒÝ› ®Ä—®‘ƒã› 㫛 ‘ƒã›¦ÊÙù 㫃㠃ÖÖ½®›Ý ãÊ ã«› ÄÊîăã®ÊÄ :
[ ] Service Recogni Ɵon [ ] Monetary, Capital or Material [ ] Recogni Ɵon of Heroes [ ] Sp ecial Feature, Area, Locale

PLEASE FILL IN ONLY THE SECTION THAT APPLIES TO THE PROPOSED NOMINATION. ADDITIONAL COMMENTS CAN BE INCLUDED ON THE SECOND (2) PAGE AND/OR OTHER RELATED MATERIALS OR COMMENTS MAY BE ATTACHED TO THIS APPLICATION.

S›Ùò®‘› R›‘ʦĮã®ÊÄ: (Individual, Group, or OrganizaƟon)

1. Was service provided in a voluntary no n-paid status or if a group or organizaƟon, was contribuƟon provided outside the normal funcƟon of a profit making organizaƟon? [ ] YES [ ] NO

2. Did the contribu Ɵon exceed five (5) years in duraƟon? [ ] YES [ ] NO

3. Is the nominee an elected or appointed o fficial?
[ ] YES [ ] NO

4. Did the contribu Ɵon have a direct posiƟve effect on the delivery of public services? [ ] YES [ ] NO

5. If the nominee is DECEASED and provided service while they were in a pay status or they were an elected or appointed official, please indicate year of death.

Year of Death
A. Did the service exceed ten (10) years in duraƟon? [ ] YES [ ] NO
Revised 01/2021
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2 MÊěãƒÙù, CƒÖ®ãƒ½ ÊÙ Mƒã›Ù®ƒ½ CÊÄãÙ®çã®ÊÄ:

1. What is the amount or value of the contribu Ɵon?
$ _________________

2. Date of contribu Ɵon: ______________________

3. Does nominee have a good record of ci Ɵzenship?
[ ] YES [ ] NO
R›‘ʦĮã®ÊÄ Ê¥ H›ÙʛÝ:

1. Did the deed for which the nominee is being honore d occur two (2) years prior to the date of consideraƟon? [ ] YES [ ] NO

2. Is the deed for which the nominee is being honored common knowledge to the ciƟzens of Richmond? [ ] YES [ ] NO

3. Does nominee have a good record of ciƟzenship?
[ ] YES [ ] NO

4. Is the nominee recognized as a naƟonal hero by an agency of the United States Government? [ ] YES [ ] NO
Name of Agency:

S֛‘®ƒ½ F›ƒãçٛ, Aٛƒ ÊÙ Lʑƒ½›:

1. Is this name appropriate to the facility?
[ ] YES [ ] NO
Please explain in comments sec Ɵon.

CÊÃÛÄãÝ:

NŽŵŝŶĂƚĞĚďLJ: DĂƚĞ:

RĞĐĞŝǀĞĚŝŶZĞĐƌĞĂƚŝŽŶŝǀŝƐŝŽŶLJ:

DĂƚĞ:

R›Øç›Ý㛗 A‘ã®ÊÄ:
[ ] Prepare for Commissioner recommenda Ɵon
[ ] Deny (ExplanaƟon)

Revised 01/2021


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