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Get Form 5W: Emergency Request To Waive Refund ... - PERS - MS.GOV

Of the Durable Power of Attorney, Conservatorship or Guardianship papers, or other legal documents as proof of authority to sign this form. Applicant s Signature: Date mm/dd/ccyy: Employer Certification This section must be completed by an authorized employer representative, not the member. Employer certification is required if date of termination is within one year of the date that this appl.

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