Along with this form, you must provide documented proof of this name or Social Security number change, which may be a copy of:. Form NC-4P Withholding Certificate for Pension or Annuity Payments.Legal Residence (County, State). Name, Street Address, PO Box, City, State, And Zip Code Of Attorney. This Directive explains the income tax consequences of the North Carolina Supreme Court's decision in Bailey v. The following is general information about the Teachers' and State Employees' Retirement System: (1). Adult Care Home and Personal Care Services Forms. Adult Care Home (ACH) Personal Care Services (PCS) Contact Information.