Required fields are marked with asterisks (*)

Request a Milestone Certificate

Request must be submitted a minimum of two weeks prior to the event. Certificates are issued at the discretion of the Municipal Clerk.

If you have already submitted a request, but would like to update it, please select "Correction" for any type of certificate request.

Requester's Contact Details

First Name

Last Name

Primary Phone Number

Email Address

Organization Name, if an organization would like to recognize someone

Select a Certificate Type

Milestone Birthday (75 years or more, in increments of 5 years)

Wedding Anniversary (25 years or more, in increments of 5 years)

Business Achievement

Correction

Other

Describe

Milestone Details

Milestone

Milestone Date

Celebration Date

Honouree's Details

First Name

Last Name

If the certificate request is for a wedding or anniversary, please fill in information for the second person below.

Honouree's Details - Second Person

First Name

Last Name

Delivery Details

Mail to Applicant

Mail to Honouree(s)

I will pick up from the Lansdowne Municipal Office

If you have any other details to add, please do so here:

For any questions regarding this program or your request, please contact the Clerk, 613-659-2415 Extension 231.

Personal information contained on this form is collected pursuant to the Municipal Freedom of Information and Protection of Privacy Act, and will be used for the purpose of your request for a Milestone Certificate. Questions about this collection should be directed to the Clerk, 613-659-2415 extension 231 clerk@townshipleeds.on.ca.

Forms

Request a Milestone Certificate