Required fields are marked with asterisks (*)

Request a Certificate

The Mayor is happy to send a certificate of congratulation to residents/businesses celebrating the following milestones.

Birthdays: Individuals celebrating a 75th birthday and over (at 5 year intervals)
Anniversaries: Couples celebrating 25 years or more (at 5 year intervals)
Business anniversaries or other milestone events

Please fill out this form to get started and submit your request 4 weeks in advance. The recipient of the certificate must be a resident/business in LaSalle. Certificates are only available upon request and will not be processed automatically for the next year, a new request will have to be made.

Requester Details

First Name:

Last Name:

Contact Phone:

Contact Email:

Certificate Details

Type of certificate requested

Birthday

Wedding Anniversary

Business Anniversary

Other

Recipient Name(s)

Delivery Details

How would you like to receive the certificate?

I will pick up at the LaSalle Civic Centre (5950 Malden Road, LaSalle)

Please mail directly to Recipient

Please mail to Requester

I would like the Mayor to present in-person (subject to availability)

Please select to confirm

I confirm that the recipient is a resident/business of LaSalle, ON.

Privacy Statement: Personal information, as defined in the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), is collected under the authority of the Municipal Act, 2001, and in accordance with MFIPPA. Personal information collected on this application form will be used by municipal staff for purposes relating to the processing of your recognition request. Questions about the collection and use of this information should be directed to Administration, and can be reached at 519-969-7770 ext. 1233.