Board Of Aldermen - Agenda - 1/2/2020 - P95
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