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Oklahoma Public Employees Retirement System 515-160-10 P. O. Box 53007 Oklahoma City OK 73152-3007 800 733-9008 405 848-5946 Fax www. opers.ok. gov Change of Address Please type or print in blue or black ink. Retired - currently drawing a retirement benefit. Oklahoma Public Employees Retirement System 515-160-10 P. O. Box 53007 Oklahoma City OK 73152-3007 800 733-9008 405 848-5946 Fax www. opers*ok. gov Change of Address Please type or print in blue or black ink. Retired - currently drawing a retirement benefit. Check one Vested - not currently working but eligible to draw a benefit in the future. Withdrawing - not currently working and in the process of withdrawing your contributions. Active - please provide your Agency name Part 1 Provide your name and Social Security number below. Name first middle last Social Security number Please provide city state and zip code even if you are moving within the same town or city. Mailing address City State Daytime telephone Zip 4 Work telephone Part 3 Provide the information requested* 1. The changes made above will change my permanent records in the following Plans SoonerSave Plans - 457/401 a Part 4 Read the following sign and date in the space provided* I understand that I must properly complete and submit this form before any changes to my permanent retirement records can be made. opers*ok. gov Change of Address Please type or print in blue or black ink. Retired - currently drawing a retirement benefit. Check one Vested - not currently working but eligible to draw a benefit in the future. Withdrawing - not currently working and in the process of withdrawing your contributions. Check one Vested - not currently working but eligible to draw a benefit in the future. Withdrawing - not currently working and in the process of withdrawing your contributions. Active - please provide your Agency name Part 1 Provide your name and Social Security number below. Active - please provide your Agency name Part 1 Provide your name and Social Security number below. Name first middle last Social Security number Please provide city state and zip code even if you are moving within the same town or city. Name first middle last Social Security number Please provide city state and zip code even if you are moving within the same town or city. Mailing address City State Daytime telephone Zip 4 Work telephone Part 3 Provide the information requested* 1. Mailing address City State Daytime telephone Zip 4 Work telephone Part 3 Provide the information requested* 1. The changes made above will change my permanent records in the following Plans SoonerSave Plans - 457/401 a Part 4 Read the following sign and date in the space provided* I understand that I must properly complete and submit this form before any changes to my permanent retirement records can be made. opers*ok. gov Change of Address Please type or print in blue or black ink. Retired - currently drawing a retirement benefit. Check one Vested - not currently working but eligible to draw a benefit in the future. Withdrawing - not currently working and in the process of withdrawing your contributions. Active - please provide your Agency name Part 1 Provide your name and Social Security number below.

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