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Get Calpers Reinstatement From Retirement

Signature of Employer Print Name of Employer Date mm/dd/yyyy Employer s Phone Number Member Signature and Certification Signature of Member Mail to PERS-BSD-145 12/13 Page 1 of 1 Completing this form is a formal request to reinstate into active membership with a CalPERS-covered Member Certification City State ZIP I request reinstatement into active CalPERS membership with the following employer in the following position. I understand that reinsta....

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