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678-6934 7455 W. Washington Ave., Suite 150, Las Vegas, NV 89128 (702) 486-3900 - Fax (702) 304-0697 Toll Free 1-866-473-7768 Website www.nvpers.org Retirement Option Reversion Form I hereby request to revert my retirement allowance from the Option to the unmodified Option 1 benefit. It is my understanding that by reverting my allowance to the unmodified Option 1 beneft, I will no longer provide a lifetime benefit for any beneficiary. I understand that the effective date of this change.

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