Certification of Peace Officers PA-1

for Police State Aid Payable in 2026

To avoid penalty, electronically submit this form by March 16, 2026

County

Peace Officer Department

Minnesota Tax ID

Add Officer

Edit	First Name	Last Name	P.O.S.T.	Original Hire Date	End Date	Months Employed	Hours per Week	Fund	Explain Unpaid Leave

Certification

Form PA-1 must be certified by the person authorized by statute; refer to the instructions for more information.

I certify that I am authorized to submit this information and that it is true and correct to the best of my knowledge. I understand that anyone giving false information is subject to a fine of up to $3,000 and/or up to one year in prison. [Minnesota Statutes, section 609.43]

Certifier Name

Certifier Title

Certifier Phone Number

Certifier Email