Congratulatory Request Form

January 4, 2022

Congratulations on your upcoming celebration. To ensure we are able to accommodate your request, please review the following information and submit the information request.

1. Please choose one:

Citation: an award granted to an individual

Certificate: honor or distinction to an individual

Proclamation: occasion/event of great historic and/or anniversary

2. Information Needed:

Requestor's Name:

Address:

Date of Event/Location:

Name of recipient:

Achievement Type:

Brief bio/background of the recipient/event:

Please forward a copy of bio and flyer announcements to: zinermans@nyassembly.gov

User Name

Assemblymember

Stefani Zinerman

Assembly District 56

Congratulatory Request Form