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VILLAGE OF ROMEOVILLE COMMEMORATIVE PROGRAM

Fallen Heroes Memorial Application Form
Updated September 1, 2021
Description:
The Village of Romeoville is offering a unique opportunity for residents to honor a current or former community member through the Commemoration Program. The program is utilized as a way to recognize individuals that have made a significant contribution or impact on the community.
APPLICATION PROCESS
The nominator should complete and submit the form. The Committee will then make a recommendation to the Village Board. Each application must meet the criteria as set forth, although meeting all criteria does not ensure naming rights. The Committee has the right to deny any application for any reason at any time or waive requirements as set forth. Applications with names or nick names that endorse or advocate religion or specific religious beliefs, have obscene connotations, or demean or attempt to intimidate any group based on the group’s race, ethnicity, age, gender, disability, or sexual orientation will be denied.
QUALIFICATIONS
To qualify, the honoree must have lost their life while on duty and lived in Romeoville during their time of service. The Village has the right to verify the information provided.
SELECTION
The completed form will be reviewed to determine if all criteria has been met. If all criteria has been met, the honoree's application will be forwarded to the Commemorative Program Committee which consists of an elected official, the Village Manager, a Village of Romeoville employee, a non-profit representative and a Romeoville resident.
NOTIFICATION
If honoree is selected, the Committee will inform the nominator and the honoree via letter.
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NOMINATOR INFORMATION

Name
Email Address
Address
City
State
Zip Code
Home Phone
Work Phone
Cell Phone
Honoree Name
Relationship to Honoree
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HONOREE INFORMATION

Name
Email Address
Address
City
State
Zip Code
Home Phone
Work Phone
Cell Phone
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QUALIFICATIONS

The Fallen Heroes Memorial is a section of the Edward “Doc” McCartan Veterans Memorial that honors the men and women who have served in one of the five branches of the armed forces and who made the ultimate sacrifice defending the freedoms of all Americans.
Please describe the service, date and duty location of the fallen hero:
Did the fallen hero live in Romeoville during the time of service?
1. Yes
2. No
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MEMORIAL PERSONALIZATION

The memorial is a 12 X 15 plaque with a 5 X 7 metal photo and other service details. Please select from the following plaque options:
1. In Loving Memory of
2. In Honor of
3. In Celebration of
4. Other
If other, please consider the below wording for consideration on the plaque:
Name of person to be engraved on plaque:
Please include any other service details to be included on the plaque:
Please upload image of fallen hero to be included on the memorial plaque.
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CONDITIONS

Checking the box indicates that I certify that all statements and information furnished in this form are true, complete and correct to the best of my knowledge, and are made in good faith. I understand that statements or information furnished on this form are subject to verification and I agree to furnish supporting documents or information when requested.
1. I have read and agree to the conditions.
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OFFICE USE ONLY

Date Approved:
Location:
Fee:
Date Payment Received:
Date Denied:
Reason for Denial:
Signature:
The completed form will be submitted via email for review and approval. For additional information, contact the Village of Romeoville at 815-886-7200.

Leave This Blank:

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

This field is not part of the form submission.
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Commemorative Program - Fallen Heroes Memorial Application Form

Steps

Step One

NOMINATOR INFORMATION

HONOREE INFORMATION

QUALIFICATIONS

MEMORIAL PERSONALIZATION

CONDITIONS

OFFICE USE ONLY

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