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OPBA Retirement Information Sheet

RETIREMENT ITEMS SHOULD BE MAILED TO YOU WITHIN 3 MONTHS FROM OUR RECEIPT OF THIS FORM.

First Name:

Middle Initial:

Last Name:

Position:

Department:

Badge Number (if applicable):

Mailing Address:

Phone Number:

Email: 

Retirement Date:

Years of Service (including bought military and other dept.)

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Do you want to remain an OPBA member?


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Ohio Patrolmen's Benevolent Association
10147 Royalton Rd Suite J
North Royalton, OH 44133
  440-237-7900

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