CENTENARIAN RECOGNITION AT PALATINE TOWNSHIP

Do you know someone who will be 100 years of age or older this year, and resides in Palatine Township?

Palatine Township needs your help identifying its centenarians – people who have lived for 100 or more years.  We would like to honor them in a number of special ways including a Certificate of Recognition, recognition in the Township’s newsletter, and, if they are able, a special Township Resolution Presentation Ceremony which includes pictures with the Board and refreshments.

Please complete the application below.  We must receive your request at least 45 days in advance of the honoree’s birthday.  We will respond to you within seven business days to acknowledge receipt of your request.  If you have questions or do not hear from us within seven business days, please contact Brad Strassburger at bstrassburger@palatinetownship-il.gov.

 

Thank you for helping us honor the men and women who have built our Palatine Township Community.

CENTENARIAN RECOGNITION REQUEST FORM

  • Please complete this form to request a special certificate and newsletter recognition for a Palatine Township Resident who will turn 100 or older within the next 4 months. Submissions are due at least 45 days in advance of the honoree's birthday.

    Please provide an accurate email address and phone number in the event that additional information is necessary.

    We would like to include a photo of the person being honored. Please email your photo to us at lmoran@palaitnetownship-il.gov along with the name of the person being honored and the date you submitted your application to the Township.

    Note: Palatine Township will need the person being honored (or his/her legal representative) to sign a photo/video release agreement.

  • Enter the name of the centenarian as it should appear on the certificate.
  • Palatine Township will request proof of age before issuing a recognition certificate.
  • Leave blank if the contact person resides with the honoree.
  • We will send status notifications to this email address.
  • This field is for validation purposes and should be left unchanged.
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