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Get OR 459-260 2012

S 9996 Special Power of Attorney (POA) for PERS This form is for all PERS retirement programs. Call or visit our website if this is not the form you need. Section A: Applicant information (Type or print clearly in dark ink. Illegible forms could be returned to you, which could delay your request.) First name MI Last name Social Security number* Mailing address (street or PO box) City PERS number (optional) State Zip Day phone number Country Evening phone number Date of birth (mm-dd-.

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