Fillable ADDRESS CHANGE (City of Providence)

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ADDRESS CHANGE (City of Providence)

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RETIREMENT BOARD | EMPLOYEE RETIREMENT SYSTEM
Providence City Hall | 25 Dorrance Street, Room 409, Providence, Rhode Island 02903
401 421 7740 ph | 401 453 6175 fax
www.providenceri.com
ADDRESS CHANGE
I, ____________________________________ SSN_________________________________
Hereby inform you that I have moved:
My Old Address is: _______________________________________________________
_______________________________________________________
_______________________________________________________
My New Address is: _______________________________________________________
_
______________________________________________________
__
_____________________________________________________
____
______ Please email electronic pay statements to me at the following
email address: __________________________________________
_____________________________ ___________________ ____________________
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ADDRESS CHANGE (City of Providence)

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Completed 4 August 2020

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