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Village
of Lindenhurst Good Citizen Award Nomination Form
Person making nomination:
_______________________________________________________
Telephone Number:______________________________Email:__________________________
Reason for nomination: (Utilize
space below, or attach letter)
Name of
nominee:______________________________________________________________
Telephone Number:______________________________Email:__________________________
Mailing
Address:_______________________________________________________________
Organization, Title,
Position:______________________________________________________
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Please
return completed form to: |
|
|
Anthony Manetta Email: AManetta@villageoflindenhurst.com Fax: 631-228-0950 |
Village of Lindenhurst Anthony Manetta - Good Citizen Award 430 S. Wellwood Avenue |