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.

Member Name:
Position:
Department:
Badge Number (if applicable):
Mailing Address:
Phone Number:
Email: 
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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