Letter Request Form REQUESTER INFORMATION Requester Name * Requester Organization/Agency * Requester Phone * Please format as XXX-XXX-XXXX. Requester Email * DELIVERY INFORMATION Mailing Address (where the completed document should be mailed): Recipient * Organization (if applicable) Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * HONOREE/EVENT INFORMATION Type of Letter * Please select the type of letter you are requesting. Birthday (for individuals turning 80 or older) Church/Organization Anniversary Eagle Scout/Gold Award Family Reunion High School Reunion Military Retirement (please send official supporting documentation to govrequests@nc.gov) Royal Ranger Award State Employee Retirement Wedding Anniversary (for 25 years or more) Welcome Message Other Birthday (for individuals turning 80 or older) Honoree Title: * Honoree First Name: * Honoree Middle Name: Honoree Last Name: * Honoree Suffix: Honoree Address (to be included on the letter): Honoree’s Full Name (exactly as it should appear on the letter) * Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Age to be Celebrated: * Additional Information about the Event/Honoree (optional): Church/Organization Anniversary Full Name of Church/Organization: * Pastor/Organization Leader Job Title or Position: * Pastor/Organization Leader Title: * (ex. Dr., Ms., Mr., Rev., etc.) Pastor/Organization Leader First Name: * Pastor/Organization Leader Middle Name: Pastor/Organization Leader Last Name: * Pastor/Organization Leader Suffix: Church/Organization Address (to be included on the letter): Pastor/Organization Leader Full Name (exactly as it should appear on the letter) * Full Name of Church/Organization (exactly as it should appear on the letter) * Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Date of Event: * Anniversary to be Celebrated: * (Example: 140th anniversary of organization’s founding) Additional Information about the Event (optional): Eagle Scout/Gold Award Honoree First Name: * Honoree Middle Name: Honoree Last Name: * Honoree Suffix: Honoree Address (to be included on the letter): Honoree’s Full Name (exactly as it should appear on the letter) * Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Troop Number: * Ceremony Date (if the date has not passed): Additional Information about the Event/Honoree: * Please provide information that describes how or why the honoree qualifies for this award. Family Reunion Family Name (exactly as it should appear on the letter): * Reunion Anniversary to be Celebrated (if applicable): Example: 30th Annual Event Date: * Additional Information about the Event (optional): High School Reunion Full Name of High School: * Graduation Year (if applicable): Reunion Anniversary to be Celebrated: * Example: 50th Class Reunion Date of Event: * Additional Information about the Event (optional): Military Retirement Military Branch: * Honoree Military Title: * Honoree First Name: * Honoree Middle Name: Honoree Last Name: * Honoree Suffix: Honoree Address (to be included on the letter): Honoree’s Full Name (exactly as it should appear on the letter) * Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Years of Service: * Ceremony or Retirement Date (preferred date to be included on letter): * Letter Presentation Date (if applicable): Additional Information about the Event/Honoree (optional): Royal Ranger Award Honoree First Name: * Honoree Middle Name: Honoree Last Name: * Honoree Suffix: Honoree Address (to be included on the letter): Honoree’s Full Name (exactly as it should appear on the letter) * Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Outpost Number: * Ceremony Date (if the date has not passed): Additional Information about the Event/Honoree (optional): State Employee Retirement Full Name of Honoree Organization/Agency/School: * Honoree Job Title or Position: * Honoree Title: * (ex. Dr., Ms., Mr., Rev., etc.) Honoree First Name: * Honoree Middle Name: Honoree Last Name: * Honoree Suffix: Honoree Address (to be included on the letter): Honoree’s Full Name (exactly as it should appear on the letter) * Full Name of Organization/Agency/School (if applicable, exactly as it should appear on the letter) Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Years of Service: * Ceremony or Retirement Date (preferred date to be included on letter): * Additional Information about the Event/Honoree (optional): Wedding Anniversary (for 25 years or more) Spouse 1 Title: * Spouse 1 First Name: * Spouse 1 Middle Name: Spouse 1 Last Name: * Spouse 1 Suffix: Spouse 2 Title: * Spouse 2 First Name: * Spouse 2 Middle Name: Spouse 2 Last Name: * Spouse 2 Suffix: Couple’s Address (to be included on the letter): Couple’s Names (exactly as they should appear on the letter) * Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Date of Event: * Anniversary to be Celebrated: * (Example: 30th) Additional Information about the Event (optional): Welcome Message Full Name of Event's Host Organization/Agency: * Host Organization/Agency Leader Job Title: * Host Organization/Agency Leader Title: * (ex. Dr., Ms., Mr., Rev., etc.) Host Organization/Agency Leader First Name: * Host Organization/Agency Leader Middle Name: Host Organization/Agency Leader Last Name: * Host Organization/Agency Leader Suffix: Organization/Agency Address (to be included on the letter): Host Organization/Agency Leader Full Name (exactly as it should appear on the letter) * Full Name of Host Organization/Agency Full Name (exactly as it should appear on the letter) Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Title/Theme of Event (if applicable): * (Example: 30th Annual Meeting of the Organization of North Carolina – North Carolina: The State Where We Live) Date of Event: * Please give a detailed description of the event and its host and/or sponsoring organization: Other Full Name of Organization/Agency Being Honored (if applicable): * Honoree Job Title or Position: (if letter is for an organization, honoree should be the organization leader – please include his/her job title) Honoree Title: * (ex. Dr., Ms., Mr., Rev., etc.) Honoree First Name: * Honoree Middle Name: Honoree Last Name: * Honoree Suffix: Honoree’s Full Name (exactly as it should appear on the letter) * Full Name of Organization/Agency (if applicable, exactly as it should appear on the letter) Street Address 1 * Street Address 2 City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Date of Event (if applicable): Please give a detailed description of the event, individual, or organization you would like recognized and why. * Correspondence to and from this website may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized state official.