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APPLICATION FOR NAMDFG <br /> A <br /> CITY OF LA PORTS FACILITY <br /> Please provide the information requested and ratan this application to the City Secretary's Office. <br /> Applicant Information <br /> Name: <br /> Address: <br /> Phone: <br /> Faeitity Information <br /> Location: <br /> Current Name: <br /> Function or Facility: <br /> Proposed Name: <br /> Contributions <br /> In the spaces provided below, briefly explain how the proposed individual,family, organization, <br /> or entity has contributed to LaPorte. You may use any combination of categories, as is <br /> appropriate to the nomination, to describe the contributions made. For fiuther assistance,please <br /> refer to the Procedures and Guidelines for the Naming of Public Facilities. <br /> Financia!Contribution <br /> Historic&Symbok Contribution <br /> Civic Contribution <br /> i <br /> 4 <br />