Form Cpd-12.150 - Retirement Letter Of Recognition Request - Chicago Police Department

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RETIREMENT LETTER OF RECOGNITION REQUEST
DATE OF REQUEST
DATE NEEDED
CHICAGO POLICE DEPARTMENT
REQUESTED BY
UNIT NAME
UNIT NO. CONTACT PERSON
CONTACT PHONE NO.
REQUESTING LETTER FROM SUPERINTENDENT
REQUESTING LETTER FROM MAYOR
NO
NO
YES
YES
LIST THE FOLLOWING INFORMATION IN THE TABLE BELOW FOR WHOM YOU ARE REQUESTING LETTERS.
EMPLOYEE
APPT.
RETIREMENT
NAME OF UNIT
UNIT
FULL NAME
RANK
STAR NO.
HOME ADDRESS
NO.
DATE
DATE
RETIRING FROM
NO.
UNIT/DISTRICT COMMANDER (PRINT)
UNIT/DISTRICT COMMANDER (SIGNATURE)
APPROVAL REQUIRED:
CPD-12.150 (9/13)

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