Retirement Citation Retirement Citation Request Form What other elected official(s) did you or plan to contact with this request? Rep. Rosemary Brown Rep. Joe Emrick Rep. Marcia Hahn Rep. Maureen Madden Rep. Zach Mako Rep. Jack Rader Sen. John Blake Sen. Lisa Boscola Sen. Pat Browne Full Name of RetireeStreet AddressCityStateZip CodeName of EmployerYears with EmployerCareer AccomplishmentsDate of Event (if applicable)Contact Person Information:NameContact E-Mail Address* Street AddressCityStateZip CodePhone NumberPlease enter telephone number using this format (2155551212)Mail Citation to: (Check one) Retiree Contact Person *Unless otherwise noted, the citation will be sent to the retiree's home.
