Senator Mike Bernskoetter

Resolution Fact Sheet - Generic


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)
Reason for resolution:
Name of honoree:
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: