Senator Mike Folmer

Communications & Technology Committee
Chair


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Retirement Citation Request Form

Full Name of Retiree
Street Address
City
State
Zip Code
Name of Employer
Location of Employer
Years with Employer
Career Accomplishments
Date of Event (if applicable)
   
Contact Person Information:
   
Name
Street Address
City
State
Zip Code
Phone Number
Mail Citation to:
(Check one) 
  Retiree    Contact Person 
   
* Unless otherwise noted, the citation will be sent to the retiree's home.


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