Hinds County Board of Supervisors

Centenarian Recommendation Form

Pearlie James Johnson
Aging Outreach Worker
4055 Volley Campbell Rd
Terry, MS 39170
 
For questions, please call any of the number(s) below.
Office Number: 601-878-2607
Office Number: 601-852-2045
Cell Number: 769-233-3971

Download a form to complete offline.

INSTRUCTIONS:

  1. All submissions must be received by the 25th day of the month.
  2. Please complete the form below.
  3. Click the "SUBMIT" button when finished.
  4. Centenarians will be recognized at the 1st Board meeting of each month.

NOTE:  Please be sure to notify our office if the Centenarian is unable to attend the Board meeting and a family member will accept the recognition on their behalf.

 

(District where the Centenarian Resides)
If the Centenarian is unable to attend this event, and a family member will attend the Board Meeting to accept the recognition, please list the family member’s name and relationship below: