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Long Island 10-13 Application
Dedicated to serving all retired and active members of Law Enforcement. Please remit payment to:
P.O. Box 477
Shoreham, NY 11786
OR
Venmo at:
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Email
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Last Name
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First Name
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Street Address:
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City
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State
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Zip
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Phone <Cell/Home>
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Sex
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Law Enforcement Affiliation
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What is the first 3 numbers in your Tax number or serial number?
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Appointment Date
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Last Command
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Last Rank Held<hold>
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Previous Command
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