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Get PA PSRS-996 2019-2024

4 Mail Center W-4P Federal Tax Withholding Certificate for Annuity Payments Please read the information on the reverse side and the instructions below before completing this form. Member Name Member Address Change Social Security Number Check here if new address Apt# or Suite Gender Delivery Address Date of Birth City State & Zip Code Former Last Name (only if used in this System) Daytime Phone Evening Phone Email Address (optional) Which monthly pension account(s) does this a.

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