Transcription of Reemployment of PERS Service Retiree Certification ...
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Reemployment of PERS Service Retiree Certification ...
public Employees retirement system of Mississippi 429 Mississippi Street, Jackson, MS 39201-1005 , fax Reemployment of pers Service Retiree Certification /Acknowledgement Form 4B Revised 11/17/2017 Please print or type in black ink. A Form 4B, Reemployment of pers Service Retiree Certification /Acknowledgement, should be submitted each fiscal year (July 1 June 30) of Reemployment . See Regulation 34 , Reemployment after retirement , for rules governing Reemployment . Completed form should be mailed or faxed to pers . See bottom of form for contact information. Retiree Information First Name: _____ MI: _____ Last Name: _____ Mailing Address: _____ City: _____ State: _____ Zip: _____ Social Security No.
Public Employees ’ Retirement System of Mississippi 429 Mississippi Street, Jackson, MS 39201-1005 800.444.7377 601.359.3589 601.359.5261, fax www.pers.ms.gov
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