Disability Retirement Election Application - CalPERS
Section 2 . Information About Your Retirement. Last Day on Payroll (mm/dd/yyyy) Your Retirement Date (mm/dd/yyyy) Employer Full Name Full Position Title. Other California Public Retirement Systems. If you are a member of a defined benefit plan with a California public retirement system other than CalPERS, please complete the following:
Download Disability Retirement Election Application - CalPERS
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