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Get NY F290 2012-2024

NYCERS USE ONLY F290 Change of Address Form This application is for members who wish to change their address that NYCERS has on file. Should you have any questions regarding this application please contact our Call Center at 347-643-3000. Member Number OR Pension Number Last 4 Digits of SSN Phone Number First Name M. I. Last Name New Address IN CARE OF IF APPLICABLE Apt. Number City State Zip Code Previous Address If you are currently receiving monthly payments from NYCERS check one of the following boxes only. Continue sending my check to the bank. Cancel sending my check to the bank. Please send my check to my new address as listed above. Signature of Member Date This form must be acknowledged before a Notary Public or Commissioner of Deeds County of On this day of personally appeared before me the above named to me known and known to me to be the individual described in and who executed the foregoing instrument and he or she acknowledged to me that he or she executed the same and that the statements contained therein are true. If you have an official seal affix it Signature of Notary Public or Commissioner of Deeds Official Title Expiration Date of Commission R07/19/12 Page 1 of 1. Should you have any questions regarding this application please contact our Call Center at 347-643-3000. Member Number OR Pension Number Last 4 Digits of SSN Phone Number First Name M. I. Last Name New Address IN CARE OF IF APPLICABLE Apt. Member Number OR Pension Number Last 4 Digits of SSN Phone Number First Name M. I. Last Name New Address IN CARE OF IF APPLICABLE Apt. Number City State Zip Code Previous Address If you are currently receiving monthly payments from NYCERS check one of the following boxes only. Number City State Zip Code Previous Address If you are currently receiving monthly payments from NYCERS check one of the following boxes only. Continue sending my check to the bank. Cancel sending my check to the bank. Please send my check to my new address as listed above. Continue sending my check to the bank. Cancel sending my check to the bank. Please send my check to my new address as listed above. Signature of Member Date This form must be acknowledged before a Notary Public or Commissioner of Deeds County of On this day of personally appeared before me the above named to me known and known to me to be the individual described in and who executed the foregoing instrument and he or she acknowledged to me that he or she executed the same and that the statements contained therein are true. Signature of Member Date This form must be acknowledged before a Notary Public or Commissioner of Deeds County of On this day of personally appeared before me the above named to me known and known to me to be the individual described in and who executed the foregoing instrument and he or she acknowledged to me that he or she executed the same and that the statements contained therein are true. If you have an official seal affix it Signature of Notary Public or Commissioner of Deeds Official Title Expiration Date of Commission R07/19/12 Page 1 of 1. .

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