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CITY OF SOUTH EUCLID
APPLICATION FOR USE OF MUNICIPAL CENTER BUILDING
TO BE ISSUED UNDER AUTHORITY OF C.O. 931.02

*****PLEASE CALL CITY HALL FIRST (216.381.0400) BEFORE SUBMITTING THE FORM to make sure your desired room is available. Rooms are only available to South Euclid residents. Certain Government and Non-profit Agencies are also eligible to use Rooms at City Hall. Contact us at the number above for more information.*****

CITY HALL ROOM USAGE FORM

Name of Organization (required):

Name of Applicant (required):

TItle:

Address:

City: Zip:

Telephone (home): Telephone (work):

Name of Organization Officer:
Title: Email:

Date Desired: Hours (Starting): To (Ending):

REGULAR MEETING DATES (Fill in Dates):
JAN FEB MAR APR MAY JUN
JUL AUG SEP OCT NOV DEC

Purpose for Use (be specific):
Is admittance charged? YesNo If yes, amount per person:
Will anything be sold? YesNo If yes, explain:
Maximum Number in Organization Attending:
Number of South Euclid Residents:

ROOM DESIRED (please check):
Community RoomJury RoomKitchenCouncil Chambers

The undersigned, a resident taxpayer of the City of South Euclid, hereby assumes the responsibility for the proper use of the accommodations applied for, and in consideration of the issuance of the permit therefore agrees to indemnify the City from any or all loss or damage accruing to the City by reason of such use.

Dated:

Organization:
Authorized Person:
Resident Taxpayer (If different from above):

OFFICE USE ONLY

Date of Application Received:

APPROVED BY, , MAYOR
(Final Decision of Issuance Rests With Above Signed)