NYCPD - REQUEST FOR CERTIFICATION LETTER RETIRED MOS

Have You Previously Requested a Letter or Transcript?

Last First Maiden

(Include Apt. #)

SS#

Yes No

If Yes, Approx. Date of Request

HousingTransitNYCPDTraining Academy:

Tax#

Home Address City ZipState

Home Phone # DOB

Date Appointed PA Company # Date Left Agency

Mail Phone Walk-in Fax Reviewed By:

LOG # DATE RECEIVED

Name

FOR OFFICE USE ONLY:

Last Rank

(Retirement Date)

DATE SENT

Agency's Information: Agency Attention Address City State Zip Code

Note: If you omit any information on this form your application will be delayed for processing or returned to you unprocessed and your request will have to be resubmitted. Processing time for this request is approximately 7-10 business days. Please return this application to: NYC Police Academy Training Records Unit, Room 833 235 East 20th Street New York, NY 10003 Phone: 212-477-9750/9610 Fax: 212-477-7125