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ID CITY Marital status: Section B. STATE COUNTY SINGLE MARRIED ZIP CODE GENDER MALE WIDOWED Optional Retirement Program Legislative Retirement System SEPARATED ST CON OFF DEDUCT OFF ST CURRENT ST RETRO RET . DATE DCT. CURRENT DEDUCT RETRO EFF. DATE TOTAL TOTAL RSD USE ONLY Consolidated Judicial Retirement System FEMALE DIVORCED Please check appropriate box for eligibility. Teachers' and State Employees' Retirement System TELEPHONE NO. Disability Income Plan of North.

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