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2. For a lasting tribute at the site of a fatal accident, the City of Papillion has established a Roadside Memorial Sign program. The roadside memorial sign is an official sign that is provided and placed by the Public Works Department. It is installed as close as possible to the site where a fatal vehicle accident occurred. The memorial consists of white lettering on a blue background, and contains the message “Please Drive Safely.”
   
   Roadside Memorial Signs may be requested within three years following the date of a fatal motor vehicle accident by a member of the immediate family of the victim. Only one sign will be permitted per victim and the sign may memorialize more than one victim. If an application is approved, the applicant will be informed in writing of the decision along with an invoice for $200 that compensates the City for its review of the application, the installation of the roadside memorial sign and its maintenance. Upon receipt of the non-refundable payment, the City shall manufacture and install the sign, and shall notify the applicant in writing when the sign has been installed. Should the sign become faded, damaged or stolen overtime, the City reserves the right to remove the sign without replacement unless a replacement application is received within 90 days from the original applicant. The City reserves the right to deny any application. Should the application be denied, a full refund of the application shall be provided to the original applicant. Once the sign is installed no additional items will be allowed at any time throughout the year at the demarcated roadside memorial.
   
   Please complete the following application.
4. Name of Individual to Be Honored*
6. Accident Location*
7. Date of Accident*
   Date of Accident
9. Details of Accident*
11. Name of Applicant*
12. Relation to Victim*
14. Address*
16. City*
17. State*
18. Zip Code*
20. Phone Number*
21. Email Address*
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23. 1. Receive an email copy of this form.
24. Email address

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25. Submit

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