Citation Request — State Representative Jack Patrick Lewis

Request a Citation from Rep. Lewis!

If you are also requesting that Representative Lewis attend an event, please fill out the event request form.

If you have questions about requesting a citation from Rep. Lewis or filling out this form, please contact Marianna at Marianna.Luciano@mahouse.gov.

Honoree's Name

This is the name of the individual or organization to whom the citation is dedicated.

Requester's Name

This is the individual or organization requesting the citation.

Requester's Email

Requester's Phone

(###)

###

####

Occasion for Recognition

Explanation

Please explain, in up to 300 words, the reason for recognition in greater detail. Using the information you provide, the citation's wording will be determined. Please know that citations hold no more than 18-21 words, not including recipients' names.

Sending Location

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Citation Date

This will appear on the citation.

MM

DD

YYYY

Event Date (if applicable)

Date of the event where citation will be delivered by the Representative or his staff.

MM

DD

YYYY

Will you or your organization be issuing a press release or other media communication about this citation?

Additional Questions/Comments

Please feel free to add any additional comments or questions below.