Fillable OPERATING ENGINEERS TRUST FUNDS

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OPERATING ENGINEERS TRUST FUNDS

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12/18/2018
Employer Change of Address
r
Fund Office Use Only
Processed By
Process Date
Copy to Local 12
Copy to Field Rep.
Return to: Operating Engineers Trust Funds, PO Box 7064, Pasadena, CA 91109
Employer Information
Employer ID(s)
Employer Name
Old Address
Street Address
Suite/Unit#
City
State ZIP Code
Phone Number
( )
Fax Number
( )
New Address
Effective Date
______/______/__________
Street Address
Suite/Unit#
City
State ZIP Code
Phone Number
( )
Fax Number
( )
Signature (required)
X
Date
______/______/__________
OPERATING ENGINEERS TRUST FUNDS
I.U.O.E. LOCAL 12 HEALTH & WELFARE / PENSION / VACATION / TRAINING
100 CORSON STREET, SUITE 100 · PASADENA, CALIFORNIA 91103 · (866) 400-5200
P.O. BOX 7063, PASADENA, CALIFORNIA 91109
TTY: (626) 356-3582 WEBSITE: www.oefi .org
rev 6_2017
rev 3_2019
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Completed 29 November 2021

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