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Application Form Proposed New Street Names and Revisions to Existing Street Names City of Albany Department of General Services One Conners Boulevard, Albany, New York 12204-2514, Telephone (518) 434-5670 Instructions: This application must be completed in full, either typed or printed, and submitted to the Division of Engineering – Department of General Services. Complete one form for each proposed street name. Include additional sheets as necessary. 1. Applicant’s Name: Address: Phone No. Fax No. 2. Proposed Street Name (check applicable box and fill in associated information) ٱNew Street List the Nearest Connecting List the Proposed Street Name Selections in Order of Priority: 1. 2. 3. ٱExisting Street Existing Street Name List the Proposed Street Name Selections in Order of Priority: 1. 2. 3. Reason for proposed change: ٱHonorary Street Proposed Honorary Name to be Placed Under Existing Street Name Location(s) of Honorary Existing Sign(s) Proposed: Existing Street Name From To Number of Honorary Sign(s) Proposed Reason for proposed name: Applicant’s Signature Date: G:\Dgs\Engineering\Forms\Street Names\Procedure and Application.doc