Service Certificates

FASNY awards certificates to volunteer firefighters who have achieved 50 years in the volunteer fire service. The 100-year certificates commemorate volunteer fire departments with 100+ years of service to their communities. The certificates are issued by the FASNY office and can be presented by a FASNY official if requested.

Service Certificate Request

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Requester Information:

Recipient Type*

Individual

Department/Organization

Requester Name*

First Last

Requester Address*

Street Address City State ZIP Code

Requester Email Address*

Requester Phone Number*

Recipient Information:

Recipient Name*

First Middle Last

Suffix

Recipient Details

Any details you can provide about the recipient will help us identify them in our database. Please check the boxes for the recipient details you can provide. Leave blank if you don’t have access to any of these details.

Mailing Address

E-mail Address

FASNY ID

Recipient Address*

Street Address City State ZIP Code

Recipient Email

Recipient FASNY ID

Recipient Department*

Other Department*

Department Type*

Department Address*

Street Address City State ZIP Code

Years in Service*

Years of Service*

Day of Presentation*

FASNY Representative Attendance*

Presentation Location*

Time*

Additional Information