Certificate of Recognition Request

2. First Name*

3. Last Name*

4. Organization

6. Email *

7. Phone Number*

9. Address*

11. City*

12. State*

13. Zip Code*

17. Person, group, or organization being recognized*

19. Why is this person, achievement, or event extraordinary?*

21. Body of Certificate of Recognition*

    The body of the certificate is limited to 130 words. Please enter your desired wording and the information you would like included in the certificate.

23. Attach a File

    If you have a document with the information or desired wording, please upload it here.

27. Would you like to pick up this certificate from City Hall or would you like a copy emailed to you? *
    -- Select One --EmailPick up

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field