Request for Retirement Letter from the Mayor

In requesting a letter from Mayor John S. Peyton, please complete the following form.  Generally it takes at least two weeks before the due date to process your request.

Your E-mail Address:

Date of Retirement:

RATE/RANK (Spell out and include special designators in parenthesis):

NAME – First/Middle/Last:

Organization and Address (Spell out):

POC:    Phone:

Special career accomplishments that are worthy of note which should be considered for mention:

Please provide the following information to include spouse and children in the letter?
Spouse's Name:
Number of children:
Names of children:

List any Community involvement (i.e. volunteer efforts, service on boards of directors, etc.)

Is Retiree remaining in Jacksonville?  Yes   No

Date Letter is needed:

Would you like to pick up the letter?   or have it mailed?