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2. 

4.  

   The Crandall Stockings for Seniors provides Christmas cheer for our Senior Citizens that are 65 or older & has the City of Crandall as their Utility Service Provider.

    

   
   

   Please complete this form in its entirety and return to Crandall City Hall no later than Thursday, December 11th. 

   
   

   If you need to return this form before/after business hours, please place the form at the City Hall night drop located at the front door slot, located at 110 S. Main Street.

6. Name of Nominee
8. Street Address of Nominee
9. PO Box
11. City of Nominee
12. State of Nominee
13. Zip Code
15. Gender of Nominee

    1. Male
    2. Female
16. Age of Nominee
17. Phone Number of Nominee
19. Name of Spouse/Partner/Roommate (if 65+)
20. Gender of Spouse/Partner/Roommate (if 65+)

    1. Male
    2. Female

22.  

    I hereby authorize the Crandall Stocking for Seniors to verify this application for stocking for Seniors.

24. Signature*

26. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. 

28. Authorization*

    1. I agree
    2. I do not agree
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field