Document Date
Meeting Description
Document Type
Meeting Date
Page Number
143
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
Page Image
