Document Date
Meeting Description
Document Type
Meeting Date
Page Number
150
APPENDIX #B:
UFPO Local 645 Professional Employees of the Nashua Police Department
DESIGNATION OF BENEFICIARY FORM
To: Nashua Police Department
Date:
| 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) (Signature)
Original: Personnel File
Copy: City of Nashua, HR Dept.
48
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