Online Proclamation and Condolence Request Form

Online Proclamation and Condolence Request Form

Deletra Hudson, City Clerk | 2120 Hord Avenue | Jennings, MO 63136
What are you requesting?
Full name of person to be recognized:

First NameMiddle NameLast NameSuffix
When do you need it? (Choose a date).

MonthDayYear
Date
What day is the honor? (Choose a date).

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
Place of Birth (City, State)
Marital status (married/widowed, etc.) Please provide the name of their spouse.
*Condolences Only* Please list immediate family members and relationship (for example: Husband/Wife - Jack or Jane; three children Jim, John, Joan; five grandchildren, etc.):
Is this person a resident of the City of Jennings? If so, how many years have they lived in Jennings?
In 25 words or less, describe what you are requesting the honor for:

0/25
Occupation, occupation location and years of service.
List community involvement (ex. organizations, church, etc.):
List positive characteristic (ex. loving, leader in the community by organizing fundraisers, etc.):
Please fill in the name, address, telehphone number and email address of the contact person for any additional information and to arrange pick up:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
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