Suffolk County Legislature Form Center

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COVID-19 Memorial


  1. 1. Suffolk County Memorial:
  2. 2. Your Loved One's Information:
  3. 3. Your Contact Information:
  • Suffolk County Memorial:

    1. Thank you for including your loved one in the Suffolk County COVID-19 Memorial, a structure with ribbons bearing the names of those who have passed away due to COVID-19.
    2. By including your loved one’s name on the COVID-19 memorial, their name will become publicly available information. If you would like to keep their name private, please indicate in the designated section on the next page that you would like a ribbon tied onto the memorial with the designation of the individual as Anonymous. Please contact Lora Gellerstein at (631) 853-4087 if you have any questions or would like additional information. Thank you.
    3. Please click continue to begin.