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2. 
3. Registration Form for Placement of Political Campaign Signs

   City Clerk Jennifer A. Zelmanski

   (586) 445-5443

5. REQUESTOR INFORMATION
7. Candidate Name*
9. Candidate Address*
11. City*
12. State*
13. Zip Code*
15. Candidate Phone Number*
19. Responsible Party for Placing Signs Name*
20. Responsible Party for Placing Signs Email Address*
22. Responsible Party for Placing Signs Address*
24. Responsible Party for Placing Signs Phone Number*
25. Date of Request*
    Date of Request
27. Detailed Description of Signs*
29. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    I further attest that either my representative or I have received permission for the placement of political signs on all properties where signs will be placed.

    1. I agree.
31. Electronic Signature*
33. Date*
35. Non-Electronic Submittal Instructions

    If you choose to print this application, please mail or hand deliver it to the City Clerk's Office- City of Roseville- 29777 Gratiot Avenue, Roseville, MI  48066.

    License will be issued by the City Clerk if approved.

Leave This Blank:


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

    This field is not part of the form submission.

42. Submit

* indicates a required field