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Get DD 2866 2003-2024

RETIREE CHANGE OF ADDRESS REQUEST/STATE TAX WITHHOLDING AUTHORIZATION Read Privacy Act Statement before completing this form. PRIVACY ACT STATEMENT AUTHORITY E.O. 9397 P. L. 92-425 effective September 21 1972 as amended and 10 U.S.C. 1401. PRINCIPAL PURPOSE S To change a member s address in the military retired pay system and allow the member to start stop or change tax withholding information. ROUTINE USE S The information on this form may be disclosed as generally permitted under 5 U.S.C. Section 552 a b of the Privacy Act. It may also be disclosed outside of the Department of Defense to the Internal Revenue Service relating to an individual s claim for tax withholding to the Department of Veterans Affairs DVA for establishment changes or discontinuing of DVA compensation to a retiree. O. Box 7130 London KY 40742-7130 DD FORM 2866 NOV 2003 REPLACES DFAS CL FORM 5110/5. Adobe Professional 7. 9397 P. L* 92-425 effective September 21 1972 as amended and 10 U*S*C. 1401. PRINCIPAL PURPOSE S To change a member s address in the military retired pay system and allow the member to start stop or change tax withholding information* ROUTINE USE S The information on this form may be disclosed as generally permitted under 5 U*S*C. Section 552 a b of the Privacy Act. It may also be disclosed outside of the Department of Defense to the Internal Revenue Service relating to an individual s claim for tax withholding to the Department of Veterans Affairs DVA for establishment changes or discontinuing of DVA compensation to a retiree. In addition other Federal state or local government agencies which have identified a need to know may obtain this information for the purpose s identified in the DoD Blanket Routine Uses as published in the Federal Register. DISCLOSURE Voluntary however failure to furnish the requested information could result in non-receipt of payments/ correspondence and/or incorrect deductions from your retired pay. PART I - CHANGE OF ADDRESS Please print all information* 1. MEMBER S NAME Last First Middle Initial 2. SSN 3. NEW CORRESPONDENCE ADDRESS a* OTHER ADDRESS INFORMATION If applicable b. NUMBER AND STREET OR ROUTE c* CITY AND STATE d. ZIP CODE 4. NEW CHECK ADDRESS Not to be used for a Financial Institution in the United States. If same as New Correspondence Address enter SAME in block 4. a* a* BANK If foreign TRUSTEE ADDRESS INFORMATION OR OTHER If applicable PART II - STATE INCOME TAX WITHHOLDING AUTHORIZATION Please print all information* Deduction from military pay for state tax withholding is voluntary. Complete this form with or without a change of address if you wish to start change or terminate state tax withholding. 5. MARK X ONLY ONE BOX BELOW* THIS FORM MUST BE SIGNED AND DATED. a* I wish to start state income tax withholding from my payments for the state and monthly amount indicated below. The monthly amount must be in whole dollars and not less than 10. 00. b. I wish to change my state and/or monthly amount for state tax withholding purposes as indicated below. .

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