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LASERS Change of Address Form
Form used to request address change of address with Louisiana State Employees Retirement System (LASERS)
Handle: Document-4122
Owner: Laiche, Karen (User-23, klaich:DocuShare)DS
Wednesday, December 15, 2010 08:38:31 AM CST
Wednesday, December 15, 2010 08:47:17 AM CST
Modified By: Laiche, Karen (User-23, klaich:DocuShare)DS
Locked By:
  • Check One: Daytime Area Code and Telephone Number Member's Birthdate (MM/ DD/ YYYY) Evening Area Code and Telephone Number SECTION 3: ADDRESS CHANGE Former Home Mailing Address New Home Mailing Address CityStateZIP CityStateZIP Agency Name Please print and sign this form.
  • org DO NOT FAX FORM NOTARY PUBLIC (Type, print or stamp name) LASERS Employee Name (Type or print) Member Email Address Agency Number (3- digits) E- mail Address Change, if applicable Recipient's E- mail Address SECTION 1: MEMBER INFORMATION Active: Member has not yet retired.
  • Retired: This selection will change your address for all: retirement correspondence, monthly retirement benefits checks and monthly LASERS DROP/ IBO account checks.
  • LASERS DROP/ IBO Account: ...
Adobe Portable Document Format (.pdf) - application/pdf
LASERS Change of Address Form as of 12-15-10.pdf
Appears In: ALL FORMS - Alphabetically Listed by Form Title DELGADO FORMS HUMAN RESOURCES FORMS
Preferred Version: LASERS Address Change Form