Board Of Aldermen - Agenda - 12/23/2019 - P99

Document Date

Fri, 12/20/2019 - 14:07

Meeting Description

Document Type

Meeting Date

Mon, 12/23/2019 - 00:00

Page Number

99

Image URL

To: Nashua Police Department

| would like to designate the following individual(s) as my beneficiary for:

Accrued Sick Leave [_ |

Accrued Vacation Leave |_|

Beneficiary #1

(Name) (Relationship)

(Address)

Beneficiary #2

{Name} (Relationship)

(Address)

(Printed Name)

81