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UNITED STATES OF AMERICA RAILROAD RETIREMENT BOARD Form G-70 08-13 PROTEST OF RECORD OF SERVICE MONTHS AND COMPENSATION FORM BA-6 CERTIFICATE OF SERVICE MONTHS AND COMPENSATION IS NOT IN AGREEMENT WITH MY RECORDS AS I HAVE SHOWN BELOW. PLEASE CHECK MY RECORD AND ADVISE ME OF YOUR FINDINGS TO OFFICE OF PROGRAMS SOCIAL SECURITY NUMBER P S - COMPENSATION AND EMPLOYER SERVICES CENTER 844 NORTH RUSH ST OTHER SOCIAL SECURITY NUMBERS USED CHICAGO IL 60611-2092 NAME NUMBER YEAR USED STREET ADDRESS OR RURAL ROUTE CITY OR TOWN STATE AND ZIP CODE SIGNATURE DATE Instructions for completing the lower portion of this form. All columns should be filled in. You can report more than one year. Fill in the year for which the Form BA-6 does not agree with your records. Show the name of the employer place of employment department or occupation and monthly earnings. NOTE---If you received earnings from more than one employer in any given month show the employer and the earnings received in the next section* Copies of any evidence of compensation received such as check stubs or Forms W-2 showing the amount of railroad retirement taxes you paid on the compensation must be attached to this form* Do not send original documents. YEAR MONTH NAME OF EMPLOYER STATE PLACE OF EMPLOYMENT CITY TOWN OR VILLAGE DEPARTMENT OR OCCUPATION EARNINGS JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC TOTAL REMARKS. Fill in the year for which the Form BA-6 does not agree with your records. Show the name of the employer place of employment department or occupation and monthly earnings. NOTE---If you received earnings from more than one employer in any given month show the employer and the earnings received in the next section* Copies of any evidence of compensation received such as check stubs or Forms W-2 showing the amount of railroad retirement taxes you paid on the compensation must be attached to this form* Do not send original documents. NOTE---If you received earnings from more than one employer in any given month show the employer and the earnings received in the next section* Copies of any evidence of compensation received such as check stubs or Forms W-2 showing the amount of railroad retirement taxes you paid on the compensation must be attached to this form* Do not send original documents. YEAR MONTH NAME OF EMPLOYER STATE PLACE OF EMPLOYMENT CITY TOWN OR VILLAGE DEPARTMENT OR OCCUPATION EARNINGS JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC TOTAL REMARKS. Fill in the year for which the Form BA-6 does not agree with your records. Show the name of the employer place of employment department or occupation and monthly earnings. NOTE---If you received earnings from more than one employer in any given month show the employer and the earnings received in the next section* Copies of any evidence of compensation received such as check stubs or Forms W-2 showing the amount of railroad retirement taxes you paid on the compensation must be attached to this form* Do not send original documents. YEAR MONTH NAME OF EMPLOYER STATE PLACE OF EMPLOYMENT CITY TOWN OR VILLAGE DEPARTMENT OR OCCUPATION EARNINGS JAN FEB MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC TOTAL REMARKS. .

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Keywords relevant to Form G-70

  • apr
  • NOV
  • AUG
  • Dec
  • Sep
  • stubs
  • completing
  • earnings
  • rural
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