Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Retirement Recognition Request

  1. Creating an account or logging in to Form Center is optional and is not required to submit this form.

  2. Certificate is for:
  3. Requestor Information:
  4. Contact Jill Bronaugh, Public Information Officer, if you have any questions regarding the requested certificate   (785) 296-3403

  5. **We will only recognize individuals whose retirement date falls within the current Fire Marshal’s tenure of 2012 to present.
  6. ***Please allow two weeks to receive certificate.
  7. Leave This Blank:

  8. This field is not part of the form submission.