Fillable STATE OF DELAWARE STATE BOARD OF PENSION TRUSTEES (State of Delaware Office of Pensions)

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STATE OF DELAWARE STATE BOARD OF PENSION TRUSTEES (State of Delaware Office of Pensions)

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CA Form (07/03)
STATE OF DELAWARE
STATE BOARD OF PENSION TRUSTEES
AND
OFFICE OF PENSIONS
McArdle Building
860 Silver Lake Blvd., Suite 1
Dover, DE 19904-2402
When Calling Long Distance Telephone (302) 739-4208
Toll Free Number 1-800-722-7300 FAX # (302) 739-6129
Email:
pensionoffice@state.de.us
www.delawarepensions.com
CHANGE OF ADDRESS
(Please print or type legibly)
DATE:
PENSIONER’S NAME: S. S. # ________-_____-__________
PREVIOUS ADDRESS:
-
ZIP + 4
NEW ADDRESS:
-
ZIP + 4
PENSIONER’S SIGNATURE: TELEPHONE: ( ) -
WE REQUIRE A COPY OF POWER OF ATTORNEY OR GUARDIANSHIP PAPERS TO BE
ON FILE FOR ANY SIGNATURE OTHER THAN THAT OF THE PENSIONER
*FAILURE TO NOTIFY THE PENSION OFFICE OF A CHANGE OF ADDRESS COULD
JEOPARDIZE ANY FUTURE PENSION BENEFITS.*
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STATE OF DELAWARE STATE BOARD OF PENSION TRUSTEES (State of Delaware Office of Pensions)

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Completed 9 August 2021

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