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Required fields are marked with asterisks (*)

Certificate Request Form

Event Details

Occasion

Business Anniversary

Wedding Anniversary

Birthday

Celebrant's Name

Additional Celebrants' Name(s) (comma separated)

Celebrant's Address

City

Province

Postal Code

Date of of Birthday or Anniversary (mm/dd/yyyy)

Date Required by (mm/dd/yyyy)

*Please note that a minimum of three weeks’ notice from the celebration date must be given in order for the certificate to be prepared in time for the occasion.

What Birthday or Anniversary is being celebrated (i.e. 90th)

Requester's Information

Name

Phone Number

E-Mail

Method of Delivery

Pick-up

Mail

Personal information on this form is collected under the authority of Section 10(1) of the Municipal Act, 2001, S.O. 2001, c.25, as amended and will be used to contact you concerning your service request and or inquiry to the City of Brantford. Questions about this collection should be directed to:

Administrative Coordinator, Office of the Mayor and CAO
City of Brantford
Brantford City Hall
100 Wellington Square
Brantford, ON N3T 2M2
Telephone: 519-759-4150
Email officeofthemayor@brantford.ca: For questions specific to the collection of personal information