- 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.
- –
ERS - Name Change Form 
