City of Charlottesville
           Request for Honorary Street Name Designation


Applicant Name: ______________________________________________

Applicant Address: _____________________________________________

                       ____________________________________________

Applicant Telephone: ___________________________________________
                        (Daytime)                    (Evening)


1.   Honorary Street names are restricted to:
         Individuals
         Organizations
         Entities
         Events
         Of local significance to Charlottesville

     A.     For whom/what are you recommending this designation?
          _______________________________________________________
          _______________________________________________________

     B.      What is the reason for this recommendation? (Applicants should
          complete a short essay of approximately 500 words that provides
          justification for the proposed honorary designation. The completed
          essay should be attached to this application form).
          _______________________________________________________
          _______________________________________________________
          _______________________________________________________
2.     Location of Proposed honorary street name designation:

     A. Street Name ________________________ (Example: Kirby Avenue)

     B. Between ____________________ and _________________________
        (example: between Neil and Wright)

       OR

       All of the street ________________________

     C. What is the proposed designation?

       _________________________________________________________
       _________________________________________________________




Please complete and mail the attached form to:

       Clerk of City Council
       City of Charlottesville
       P. O. Box 911
       Charlottesville, VA 22902