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STATE of CONNECTICUT OFFICE of the STATE COMPTROLLER Page 2015-2023
Organization. This payee designation will be accepted by RSD and will be sufficient for direct deposit changes. For direct deposit and direct deposit changes only RSD will accept a copy of the Representative Payee designation made by the Commissioner of Social Security. I. SOC SEC NO. EMPLOYEE NO. MEMBER S ADDRESS Street No. Name City State Zip Code PART III - DESIGNATION OF ATTORNEY- IN-FACT AGENT Type or Clearly Print This Information The individual you wish to designate as your...
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