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?*

ProclamationCondolence
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
To help us avoid spam, please enter the words you see here:*
Should be Empty: