PAFE Form | LA County Supervisor Holly J. Mitchell

Second District Certificate Request Guidelines

Form v2.0 - Sept. 2022

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

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.

Event Date

Date to be printed on scroll

Requester's Information

Requester's First Name

Requester's Last Name

Requester's Name of Organization:

Address of Requester

City

State

Zip Code

Requester's Email

Requester's telephone number (no spaces, no dashes, no parentheses)

(Optional) If requesting “whereas” language, please input suggested wording.
Keep language to a 200 maximum word limit:

Honoree Information

Honoree's First Name

Honoree's Last Name

Name of Organization:

Address of Honoree:

City

State

Zip Code

Title of Event

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

Delivery

Delivery Method

First Name

Last Name

Address

City

State

Zip Code

The form was sent successfully.

An error occured.

Please Note:

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.

Second District Certificate Request Guidelines

Form v2.0 - Sept. 2022

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

Requester's Information

Honoree Information

Delivery

Contact Us