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Get PA PSRS-631 2015-2024

) Mail Center Option Designation (For Option Change – Due to Death) SS# Name Monthly Payment Plan (complete only the plan you want -- leave others blank) * * * * * YOUR SELECTION IS IRREVOCABLE * * * * * Maximum Option I elect to continue to receive my current check amount. Upon my death, the check for the month in which death occurs will be prorated to the date of death and will be payable to my estate with no further benefits for a beneficiary. Date Your Signature This option is not .

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