Get PA PSRS-248-3 2014
R POA Non-Durable Affidavit PSRS-248-3 (08/2014) Last Four Digits of SSN# PSERS Member s Name I, , (Name of Agent) certify under penalty of perjury that (Member), granted me authority as an agent pursuant to that certain power of attorney dated . I further certify that to my knowledge: (1) The Member is alive and has not revoked the Power of Attorney or my authority to act under the Power of Attorney and theref.
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