NYCERS USE ONLY F204 Mail completed form to 30-30 47th Avenue 10th Fl Long Island City NY 11101 New York Public Employee Retirement System Special Durable Power of Attorney This is a Public Retirement System Special Power of Attorney prepared pursuant to General Obligations Law Article 5 Title 15. This form has been prepared and circulated by the public retirement systems listed below as a convenience to their members retirees and beneficiaries. This form is limited to retirement benefit transactions involving those retirement systems and does not apply to any other matters. If you have any questions regarding this form please contact our Call Center at 347 643-3000. Member Number OR Pension Number Last 4 Digits of SSN Daytime Phone Number First Name M. I. Last Name a PURPOSE CLAUSE The purpose of this Power of Attorney document is to authorize my agent to act in my name place and stead with respect to retirement benefit transactions and my interest in benefits provided by one or more ....
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How to fill out the NY NYCERS F204 online
The NY NYCERS F204 form serves as a Special Durable Power of Attorney specifically for retirement benefit transactions. This guide will provide you with clear and supportive instructions on how to complete the form online, ensuring you understand each step of the process.
Follow the steps to complete the NY NYCERS F204 online.
- Press the ‘Get Form’ button to access the form and open it in your chosen editor.
- Begin by entering your member number or pension number along with the last four digits of your social security number, and your daytime phone number.
- Fill in your first and last name along with your middle initial.
- Proceed to the purpose clause section. This outlines the intent of the Power of Attorney. Ensure that it reflects your wishes regarding the authority being granted to your agent.
- Designate your primary agent(s) by entering their names and addresses. If you have multiple primary agents and wish them to act separately, make sure to initial the appropriate statement.
- If applicable, designate one or more successor agents in case your primary agent(s) are unable or unwilling to serve. Ensure you initial indicating whether they may act separately.
- In the grant of authority section, review the specific powers you are granting to your agent and confirm they are in line with your expectations.
- If you have additional provisions or modifications, detail them in Section (g) as necessary.
- Sign the form on page 3 in the presence of a notary public and two disinterested witnesses. Their signatures are required on the next page.
- Complete the witness signatures section by having both witnesses sign and provide their information.
- Finally, save the changes, download, print, or share the completed form as needed.
Complete your NY NYCERS F204 form online to efficiently manage your retirement benefits.
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