Senator Gina Walsh

Courtesy Resolution Fact Sheet - Retirement

First, please give us your name, address, phone and email address.
Name:
Address:
City:
State:
Zip:
Phone:
Email address:
Now we need information regarding the resolution.
Date Resolution Needed: (mm/dd/yyyy)
Name of retiree:
City of residence:
Current place of employment:
Date of retirement:
Current position:
Previous position(s):
Years of service at current place of employment:
Special duties, assignments or accomplishments:
Former place of employment:
Position(s) held:
Number of years:
Community service, memberships:
Names of family members and their relationship to honoree:
Other pertinent information:
Mailing instructions: