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Get CA PERS-OSS-138 2017

Date (mm/dd/yyyy) Address Social Security Number or CalPERS ID ( ) City PERS-OSS-138 (9/17) State Page 1 of 5 ZIP Daytime Phone Relationship Put your name and Social Security number or CalPERS ID at the top of every page Section 3 You must check a box to indicate whether you are granting the specific authority to your attorney(s)-in-fact. If you do not check a box, your attorney(s)-in-fact will not be granted this specific authority. See A Guide to the CalPERS Special.

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