Application For Refund of Retirement Deductions Civil ...

Retirement System Application For Refund of Retirement Deductions Civil Service Retirement System To avoid delay in payment: (1) Carefully read and comply with all instructions; (2) Complete application in full; (3) Typewrite or print in ink. Form Approved: OMB Number 3206-0128 1. Name (last, first, middle) 2. Date of birth (mm/dd/yyyy) 3 ...

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