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Get Mi R0311c 2022-2024

LING ADDRESS REPORTING UNIT LAST WORKED CITY, STATE, ZIP CODE EMPLOYMENT END DATE MEMBER ID OR SSN HOME TELEPHONE EMAIL ADDRESS Use this form if your employment has terminated and want to withdraw your pension contributions on account with the retirement system. This may forfeit your rights to a future pension with the retirement system. See refund instructions before completing. If you are eligible for a pension and married, you and your spouse must complete the Refund Certification and.

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