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FORMS

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BENEFICIARY FORM

- Beneficiary Designation Form - Active Members (File Size: 20kb)

- Beneficiary Designation Form - Retired Members (File Size: 22kb)


W-4P TAX WITHHOLDING FORM

- 2010 W-4P Federal Withholding Form (File Size: 93kb)

- 2010 California State Tax Withholding Form (File Size: 62kb)

- 2009 California State Tax Withholding Form (File Size: 75kb)

- 2009 W-4P Federal Withholding Form (File Size: 255kb)


HEALTH AND DENTAL ENROLLMENT

- Medical Dental Vision Enrollment Form (File Size: 96kb)

- Blue Shield Medicare Rx Form (File Size: 140kb)

- Blue Shield Declaration of Disability for Overage Child (File Size: 47kb)

- Kaiser Senior Advantage Election Form (California) (File Size: 121kb)

- Kaiser Senior Advantage Disenrollment Form (CA) (File Size: 103kb)

- Kaiser Medicare Out of Area Form (File Size: 84kb)

- Kaiser Senior Advantage Election Form (Northwest) (File Size: 200kb)

- PacifiCare ACN Group Nomination Form (File Size: 42kb)

- Standard Life Ins - Dependent Conversion Form (File Size: 335kb)


RECIPROCITY ELECTION

- Reciprocity Election Form (File Size: 83kb)


CHANGE OF ADDRESS

- Change of Address Form (File Size: 109kb)

- Name Change Form (File Size: 103kb)


APPLICATION FOR RETIREMENT

- RP-2 Application for Retirement (File Size: 83kb)


AUTOMATIC DEPOSIT

- Automatic Deposit (File Size: 90kb)


PURCHASE OF SERVICE CONTRACT

 




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