Certificate Request – LA County Supervisor Holly J. Mitchell

Second District Certificate Request Guidelines

Form v2.1 – August 2025

Please read the criteria below before completing a certificate request form.

Before completing the form, please confirm that you and most importantly, the honoree, reside in the Second District. If you’re unsure, you can verify your address using this link.

Certificates are provided as a courtesy and issued by Los Angeles County Supervisor Holly J. Mitchell to recognize and honor individuals for their contributions to Los Angeles County.

Certificates are issued to recognize milestone occasions of exceptional significance.

Certificates are only issued to current Second District residents or organizations within the District.

One certificate will be provided per organization or individual per year.

The honoree must have made a significant contribution to Los Angeles County.

You may not request a certificate for yourself.

The Supervisor’s office reserves the right to rescind a certificate if false or misleading information was provided in the application.

The Supervisor’s office reserves the right to decline any certificate request.

Our office is not responsible for the timeliness or delivery status.

If you select ‘Mail’, your order will be sent via regular USPS mail (not certified). Please ensure that you submit your request at least 4 weeks in advance of the desired delivery date. Our office is not not responsible for the timeliness or delivery status.

For out-of-county and out-of-state honorees/organizations, please submit your request to the current Board Chair. You can find the current Chair’s contact information on the Board of Supervisors’ website here.

If you need to request more than 10 certificates, please email the Scrolls team at 2ds-scrolls@bos.lacounty.gov for additional instructions. This will help avoid filling out this form multiple times.

Certificates and commendation requests must be submitted 4 weeks prior to the date needed. Requests will be reviewed and the requestor will be notified of approval or denial in a timely manner. Due to the high volume of requests, the Supervisor’s office may not be able to accommodate your request even if the criteria outlined above are met.

Event Date(Required)

Date to be printed on scroll(Required)

Requester's Information

Requester's First & Last Name(Required)

First Last

Requester's Name of Organization:

Requester's Address(Required)

Street Address City State ZIP Code

Requester's Phone(Required)

Requester's Email(Required)

(Optional) If requesting “whereas” language, please input suggested wording. Keep language to a 200 maximum word limit. Please note that our office has the discretion of what language will end up on the scroll.

Honoree's Information

You can only add up to 5 honorees per form.

Name(Required)

Prefix First Middle Last Suffix

Honoree's Name of Organization

Honoree's Home Address(Required)

Street Address City State ZIP Code

Title of the Event(Required)

Reason for Honor: (if Memoriam, please include date of birth and date of passing)(Required)

Add Another Honoree

Delivery Method

📅 Our office is not responsible for the timeliness or delivery status.

✉️ Your order will be sent via regular USPS mail (not certified). Please ensure that you submit your request at least 4 weeks in advance of the desired delivery date. Our office is not not responsible for the timeliness or delivery status.

🌍 For out-of-county and out-of-state honorees/organizations, please submit your request to the current Board Chair. You can find the current Chair's contact information on the Board of Supervisors' website here.

Please Complete Delivery Information Below:

📍 Pick up instructions.

Pick up will be at the Hall of Administration, located at 500 West Temple Street, Suite 866, Los Angeles, CA 90012 . Our team will reach out once your order is ready for pickup.

Name(Required)

First Last

Address(Required)

Same as Requesters' Address

Street Address City State ZIP Code

Location within the Second Supervisorial District.

Please confirm that the honoree or organization is located within the Second Supervisorial District:(Required)

Yes, the honoree or organization is located within the Second Supervisorial District.