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2. 
3. Centenarian Recognition Program

   Celebrating Randolph County residents who are 100 years of age or older.

   Please make requests at least two weeks before the Centenarian's birthday. The Sheriff’s Office will mail/deliver birthday greetings and a certificate honoring the special centenarian. Honorees must be residents of Randolph County.

   
   

5. (Mr., Mrs., Ms. Miss, Mx., Dr., etc. if desired)
7. Name
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
17. Birthdate
19. Place of Birth
21. Requestor's name
23. Name
24. Email Address
26. Address
28. City
29. State
30. Zip Code
32. Phone Number
34. Requestor's relationship to the honoree
36. Any specific visiting/mailing instructions, if other than to the honoree's address
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

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