Transcription of Application for Service Retirement (VRS-5)
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Application FOR Service Retirement . virginia Retirement SYSTEM 1. Social Security Number Box 2500 richmond , virginia 23218-2500. Toll Free 1-888-VARETIR (827-3847). 2. Check One Fax 804-786-9718. Original Application Clear Form Revised Application PART A. MEMBER INFORMATION. 3. Name (First, Middle Initial, Last). 4. Address (Street, City, State and Zip+4). 5. Are you a virginia resident? 6. Are you a citizen? Yes No Yes No 7. Marital Status Never Married Married or Separated Widowed Divorced Date of Divorce (mm/dd/yyyy). 8. Home Phone Number 9.
VIRGINIA RETIREMENT SYSTEM Richmond, VA23218-2500-free 1 -888 827 3847 ... 31. STATE OF VIRGINIA INCOME TAX WITHHOLDING (Choose one option below. You are not required to have Virginia state ... Submit your application to the Virginia Retirement System (VRS) at least 60 days, but not more than four
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