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ERS - Name Change Form

 

Handle: Document-81239
Owner: Fuller, Tina (User-7387, tfuller:DocuShare)DS
Monday, March 19, 2012 09:39:43 AM EDT
Wednesday, October 23, 2013 09:11:31 AM EDT
Modified By: Dickenson, Rhonda (User-8396, rhonda.dickenson:gvwfl)DS
Locked By:
  • Name Change Notice
RS 5483 (Rev .
  • 2/11)
Office of the New York State Comptroller New York State and Local Retirement System Employees’ Retirement System Police and Fire Retirement System 110 State Street, Albany, New York 12244-0001 PLEASE PRINT CLEARLY USING CAPITAL LETTERS.
  • The number will be used in identifying retirement records and in the administration of the Retirement System.
  • The records are necessary to determine eligibility for and to calculate benefits.
  • The System may provide certain
information to participating employers.
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
ERS - Name Change.pdf
No
4
92208
No
Appears In: Payroll Dept.
Preferred Version: ERS - Name Change Form