Certificate of Recognition Request

2. Certificate of Recognition

4. Certificates of Recognition are issued to recognize special events in peoples’ lives or for an organization’s special event. The primary reasons for issuance include:

   • Retirement – the person must have been employed with their current employers for 25 years or more. 
   • Birthday – the person must be at least 80 years of age.
   • Wedding anniversary – 25 years or more. 

   Please complete the from below and submit at least 30 days before the recognition is needed. Submission of this request will be reviewed and processed by the Mayor. Submission of this request does not guarantee that it will be fulfilled.

8. Requestor Information
10. First Name
11. Last Name
13. Address1
15. Address2
17. City
18. State
19. Zip
21. Email
22. Phone Number
26. Honoree Information
28. First Name
29. Last Name
31. Please describe why the recipient should be honored by the Mayor of Council Bluffs?
33. Will this recognition be displayed at an event? If yes, please describe the event
34. Date of the event
    Date of the event

    Date of the event
36. If no, will this certificate be mailed?
40. Organization Information
42. Name of organization
44. Mission of organization
46. Brief biography of the recipient
48. Accolades of recipient
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field