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Get ND SFN 2560 2018-2024

Rth Dakota 58502-1657 (701) 328- 3900 • 1-800-803-7377 • Fax 701-328-3920 *In compliance with the Federal Privacy Act of 1974, the disclosure of the individual's social security number on this form is mandatory pursuant to 26 U.S.C. Sec. 3402. The individual's social security number will be used for tax reporting and as an identification number. PART A MEMBER INFORMATION Name (Last, First, Middle) Married Single NDPERS Member ID Divorced Widowed Last Four Digits of Social Security Number .

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