Use this form to request a Certificate of Service for individuals or organizations  starting at 50 Years You may request multiple names for each service year they must be the same organization.

Indicates Required Field

Date opened:		04/27/2025 1013
Type of Certificate Requested :		Individual Organization
Name of Requester:
Requester Email:
Requestoer Phone #:
Name of Recipent :
Organization :
Year of Service :		Select Below 50 55 60 65 70 75 80 85 90 95 100 125 150 200
Date to be presented:
Presentation Details
Would you like a DCVFFA Officer to present the Certificate:		Yes No
Place and Address of Presentation:
Date and Time of Presentation:		00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23  : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59
Special Notes: