Withdrawal Application (RS5014)
Membership Withdrawal Application Received Date RS 5014 (Rev. 11/18) Please type or print clearly in blue or black ink NYSLRS ID Social Security Number [last 4 digits] Retirement System [check one] XXX-XX-Employees’Retirement System(ERS) Policeand Fire’ Retirement System(PFRS) I am requesting to terminate my membership with the system ...
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