Certificate/Citation Requests

My office is pleased to send greetings for acknowledgement of accomplishments and special occasions such as retirement, anniversary, birthday, or scout honors. If you would like to obtain a citation from my office, please use the proper form below. Please note scouting citations are only issued for the rank of Eagle Scout and Gold Award; retirement citations are given for 30 or more years of service; anniversary greetings are issued for 50 or more years of marriage; and birthday citations are for those 80 years of age and above.

Your request should be received at least four weeks in advance of the event date. Every effort will be made to honor every request, but we cannot guarantee a greeting if this deadline is not met.

Requestor Information

First Name
Last Name
Street Address
City
State
Zip Code
Email Address
Daytime Phone

Certificate

Type of citation:

Retirement (provide years of employment, company/employer, location, special accomplishments/achievements)

Honor/Misc. (Man of the Year, Community/National Award, etc.)

Eagle Scout (provide troop number, Eagle Scout Project, troop location, leadership positions, parents names)

Girl Scout (provide troop number, Gold Award Project, troop location, leadership positions, parents names)

Birthday (provide which birthday, i.e. 75th, etc., birth place, children, grandchildren, great grandchildren, spouse)

Anniversary (provide which birthday, i.e. 50th, etc., along with information on children, grandchildren, great grandchildren, where couple resides, site/date of marriage, married by (name of clergy), maiden name)

Condolence (provide name, date of birth, date of death)

Athletic Accomplishment (provide team name, roster, specific accomplishment, coach, school district, school name)

Event date/date needed

Mailing Information (if different than requestor):

First Name
Last Name
Street Address
City
State
Zip Code

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