The Secretary of the State of Connecticut
Requests may be e-mailed to or faxed to 860.509.6209
Please fill in the required information below:
Office of the Secretary of the State of Connecticut
Secretary of the State Denise W. Merrill
Would like to recognize
Why is this individual being recognized:
(ex. Your hard work and dedication within
your community)
Name as it should appear on the certificate:
If there are multiple recipients for the same
award please separate each name with a
comma. (ex. Sarah Smith, Emma Ross)
Name of award:
(ex. 2016 Lifetime Achievement Award)
Date to appear on the bottom of the
Please complete the information below regarding the contact person. Certificates will be mailed to this person.
Title (if applicable):
(including zip code)
Phone number:
Email address:
If you have any questions or require additional information please contact Lourdes Montalvo at or