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Orm Important: Please read instructions carefully before completing this form. Submit this form directly to DRS. Check one: c Public Employees c School Employees (non-teachers) c Judicial c Teachers c Law Enforcement Officers & Fire Fighters c Public Safety Employees c State Patrol Member/Retiree Information Member/Retiree Name (Last, First, Middle) Social Security Number Your Information Name (Last, First, Middle) Mailing Address City Daytime Phone Number ( Socia.

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