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Get PA PSRS-1301 2012

B Address: www.psers.state.pa.us PSRS-1301 (08/2012) Change of Address for PSERS Retirees Instructions: If you are a PSERS retiree, please use this form to submit your change of address to PSERS. If you are an active PSERS member, you must submit your change of address to your employer--DO NOT use this form for this purpose. Your Name: (Last, First, Middle Initial) Your Social Security Number: Address FORMER ADDRESS Address City State Zip Code State Zip Code Address NEW ADDRESS Addr.

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