Ohio Patrolmen's Benevolent Association
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.)

Do you want to have a picture for the Police Beat Magazine?

Do you want to remain an OPBA member?


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