Admiralships

 

 

 

Date of Request: ††††††† _________________________________________________________

Person Requesting: ††† _________________________________________________________

††††††††††† Address: †††††††† _________________________________________________________

††††††††††††††† ††††††††††††††††††† _________________________________________________________

Phone: ††††††††††† _________________________________________________________

Name of Admiral: ††††† _________________________________________________________

††††††††††† Address:††††††††† _________________________________________________________

††††††††††††††††††††††††††††††††††† _________________________________________________________

Date of Admiralship*: _________________________________________________________

Please mark appropriate box:†† Pick Up†† †† Mail to Nominee††† Mail to Nominator

Date Due:††††††††††††††††††† _________________________________________________________

Reason for Nomination (Please include contribution to the citizenry of Nebraska): ___________________________________________________________________________

___________________________________________________________________________

 

 

 

 

 

*Received date will be used if no date is provided.

Please return to Noelle Rupiper, Office of the Governor, State Capitol, P.O. Box 94848, Lincoln, Nebraska 68509 with appropriate notice of two to three weeks.

 

For Governorís Office Only

Approved: _____________________

Governorís Signature: ____________

Complete: ______________________