Board Of Police Officer Relief

Per RI General Law 45-19-2, within the Department of Labor and Training there is a board of police officer's relief consisting of seven members which administers the fund for the relief of police officers.

Please complete the required forms below. Forms can be filled out online, printed and signed. Some forms must be notarized. Please use checklist to make sure you've included all required documentation. Incomplete forms will not be processes

Mail all forms to:

    Relief of Injured and Deceased Police and Fire Fighters
    Rhode Island Department of Labor and Training
    1511 Pontiac Avenue, Building 73-2
    Cranston, RI 02920

Please email questions to DLT.PoliceFire@dlt.ri.gov

Annuity Forms

• One Time Death Benefit Application
• Petition for Widow Benefits
• Affidavit (Annual)
• Direct Deposit Authorization
• W-9 Payer's Request for Taxpayer Identification Number and Certification
• Change of Address Form
• Death of Widow or Dependent Form

Checklist of items to include with your application for benefits

• Death Certificate (if applicable)
• Letter from Police Department stating dates of service
• Copies of Birth Certificates for Dependent Children (if applicable)
• Form W-9
• Direct Deposit Application

RI General Law 45-19-4

Tuition Reimbursement

Forms must be completed by the following dates

• Fall Semester: June 30
• Winter Session: September 30
• Spring Semester: October 30
• Summer Session I: March 31
• Summer Session II: April 30
• Eligibility Application for Tuition Benefits
• Tuiton Request Affidavit - Deceased
  (include Death Certificate)
• Tuition Request Affidavit - Disabled
• Statement of Officer

First time applicants must also include:

• A copy of their Birth Certificate
• A Letter from the Police Department stating dates of service of their parent

RI General Law 45-19-4.1