DIRECT DEPOSIT INFORMATION AND AUTHORIZATION FORM
(1) CHECK BOX IF YOU ARE A RETIRED MUNICIPAL EMPLOYEE (2) RETIREE/ANNUITANT NUMBER (formerly employee number) (3) RETIREE/ANNUITANT SOCIAL SECURITY NUMBER (4) RETIREE/ANNUITANT NAME (Last) (5) CURRENT MAILING ADDRESS (If change in address please complete Form CO-1082) DIRECT DEPOSIT ACCOUNT INFORMATION (6) BANK NAME ................
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