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EDITS RS 6221 110 State Street, Albany, New York 12244-0001 Phone: 1-866-805-0990 or 518-474-7736 Fax: 518-402-4433 E-mail: nyslrsinfo osc.state.ny.us Web: www.osc.state.ny.us/retire EMPLOYER NAME AND ADDRESS (Rev. 7/09) In reply refer to Reg. No: S. S. No: Unit: Re: User ID: Ret. Date: Location Code: THE INFORMATION REQUESTED BELOW IS NEEDED TO ACCURATELY CALCULATE THE RETIREMENT BENEFIT OF THE ABOVE NAMED MEMBER. NO RETIREMENT BENEFITS WILL BE PAID TO THE EMPLOYEE LISTED ABOVE UNTI.

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