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2. Date
   Date
4. Requester Contact Information
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Postal Code*
15. Phone Number*
16. Fax Number
17. Email Address*
19. Recipient Information
21. First Name*
22. Last Name*
24. Address*
26. City*
27. State*
28. Postal Code*
30. Phone Number*
31. Occasion Details

    1. Birthday

    1. Wedding Anniversary
33. Age in Years

    1. 90

    1. 100 and Over
34. Birth Date
36. Anniversary Date
37. Years of Marriage

    Requests are accepted for 50, 60, or 70 or more anniversaries.

    1. 50
    2. 60
    3. 70 or More
38. How many years?
40. For All Celebrations
42. Will there be a formal celebration?*

    1. Yes

    1. No
44. Date & Time of Celebration
    Date & Time of Celebration

    Date & Time of Celebration
45. Address
47. City
48. State
49. Zip Code
51. Mayor to attend to present the gifts?

    1. Yes
    2. No
52. Additional Information or Comments
54. By checking here, I (we) hereby acknowledge that the personal information collected on this form is collected with my consent in accordance with Section 27 of the Freedom of Information and Protection of Privacy Act.

    1. I accept
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56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field