Request a Certificate

Required fields are marked with asterisks (*)

Would you like to request a certificate from the Mayor to commemorate an important birthday, anniversary or milestone event? We'd love to accomodate. Please submit your request 4 weeks in advance. Fill out this form to get started. The recipient of the certificate must be a resident of Kingsville.

Requester details

First Name:

Last Name:

Contact Phone:

Contact Email:

Certificate details

Type of certificate requested

Birthday

Anniversary

Business Anniversary

Other

Recipient Name(s)

Date of birth or anniversary

Milestone achieved (50, 60, 70, 80, etc)

Delivery details

How would you like to receive the certificate?

I will pick up at Town Hall (2021 Division Road N. Kingsville)

Please mail to recipient

I'd like the Mayor to present in-person (subject to availability)