City of Miami
Office of Film and Entertainment
Signature Survey Form
Special Events (including film and road closures) occurring in the City of Miami are required to notice
abutting Property owners and to provide to the Neighborhood Enhancement Team (NET) the sign-off
from residents, Business, condominiums and/or empty land owners affected by the event. This form will
be evaluated and attached to the Special Events application. (Please submit the forms via facsimile at
(305)400-5018 or in person. 444 SW 2nd Avenue, Miami, Florida 33130, 10th Floor)
Name of Event: ___________________________________________________
Produced by: _____________________________________________________
Contact Name: ____________________________Phone Number: ___________________
Email: ___________________________________Date of Event _____________________
(Film, Parades, Road Closures)
Description of Event:
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________.
Specific
Request:______________________________________________________________________________
_____________________________________________________________________________________
________________________________________________________________
_______I have been notified and do not have any concerns regarding the special event.
_______I have the following concerns regarding the proposed event: ________________________
Print Name and Business and/or Condominium: _______________________________
(Signature) : _________________________________
Address Email Address (Phone is optional): _________________________
_______I have been notified and do not have any concerns regarding the special event.
______I
have
the
following
concerns
regarding
the
proposed
event:
________________________________
Print Name and Business and/or Condominium: ____________________________________
(Signature): _____________________________________
Address Email Address (Phone is optional): ____________________________________
City of Miami
1
Office of Film and Entertainment
Signature Survey Form
_____I have been notified and do not have any concerns regarding the special event.
_____I have the following concerns regarding the proposed event:
_________________________________
Print Name and Business and/or Condominium: ______________________________
(Signature): ________________________________________
Address Email Address (Phone is optional): ___________________________________
_____I have been notified and do not have any concerns regarding the special event.
_____I have the following concerns regarding the proposed event:
_________________________________
Print Name and Business and/or Condominium: _______________________________
(Signature): ________________________________________
Address Email Address (Phone is optional): _______________________________________
_____I have been notified and do not have any concerns regarding the special event.
_____I have the following concerns regarding the proposed event:
______________________________
Print Name and Business and/or Condominium: ______________________________
(Signature): __________________________________________
Address Email Address (Phone is optional) ____________________________________
_______I have been notified and do not have any concerns regarding the special event.
_____I have the following concerns regarding the proposed event: ___________________________
Print Name and Business and/or Condominium: __________________________________
(Signature): _________________________________________
Address Email Address (Phone is optional): _____________________________________
_____I have been notified and do not have any concerns regarding the special event.
_____I have the following concerns regarding the proposed event:
_________________________________________
Print Name and Business and/or Condominium: ___________________________________
(Signature): _________________________________________
Address Email Address (Phone is optional): _____________________________________
_____I have been notified and do not have any concerns regarding the special event.
_____I have the following concerns regarding the proposed event:
________________________________
Print Name and Business and/or Condominium: _______________________________
(Signature): __________________________________________
Address Email Address (Phone is optional): ____________________________________
2