Senator Mike Cierpiot


Courtesy Resolution Fact Sheet - Generic

First, please give us your name, address, phone and email address.

Name:


Phone:


Email address:



Now we need information regarding the resolution.


Date Resolution Needed: (mm/dd/yyyy)



Reason for resolution:

Name of honoree:



Address:




City:




State:



Zip Code:



City of residence:



Occupation:



Memberships:


Awards/Honors:


Name of spouse or parents:



Names of other family members and their relationship to honoree:


Other pertinent information:
Mailing instructions:




 

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