Fillable Change of Address for Benefit Recipients

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Change of Address for Benefit Recipients

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Rev. 08/18
Public Employees’ Retirement System of Nevada
693 W. Nye Lane, Carson City, NV 89703 (775) 687-4200 Fax (775) 687-5131
5740 S. Eastern Avenue, Suite 120, Las Vegas, NV 89119 (702) 486-3900 Fax (702) 678-6934
Toll free 1-866-473-7768 Website: www.nvpers.org Email: nvpers@nvpers.org
Date Received
Change of Address for Benefit Recipients
□ Your Retirement Benefit □ Beneficiary/Survivor Benefit □ Alternate Payee Benefit
Name: SSN:
New Address:
Daytime Phone:
Personal Email:
Please check ONE of the following:
I am only changing my address.
Please continue with my current direct deposit instructions.
Please mail my check to the new address listed above.
NOTE: If you have direct deposit, checking this box will end your direct deposit.
______________________________________________________________________________
Signature Date
FOR PERS USE ONLY
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Change of Address for Benefit Recipients

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Completed 8 October 2021

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