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AFTER JANUARy 4 1973 Enter 2 character special condition code if applicable. See instructions PRINT OR TYPE First names and initials of employee and spouse Last name Home address number and street Apt. no. City and State Zip Code NYC Department or Employee Agency where employed Address Change Country if not US Spouse n Name A. n MARRIED FILING JOINTLY OR SURVIVING SPOUSE B. DATE RETIRED FROM NYC SERVICE. SPOUSE S SOCIAL SECURITY NUMBER B. EMPLOYEE HEAD OF HOUSEHOLD C. n CHECK BOX IF YOU AND...
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