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Get OPM SF 3106 2011

) Type or print in ink. Federal Employees Retirement System 1. Name (last, first, middle) 2. Date of birth (mm/dd/yyyy) See the attached sheets for instructions and information concerning your application for refund of retirement deductions and a Privacy Act Statement. 3. Social Security Number 4. List all other names you have used (including maiden name, if applicable.) 5. Your address (number and street, city, state and ZIP Code) - We cannot authorize payment if this address is erased or .

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