PEF RETIREES

RENEWAL CARD

(Please print)

Social Security Number:  __  __ __ - __ __- __ __ __ __Retirement Date:  __________________

Name: _______________________________________________________________________

Address:  _______________________________City:  _________________________________

State:  _____________________Zip:  _____________________ NY County:  _____________

Telephone: (______) _________________________E mail address:  ______________________

Return your completed renewal card and signed $21 check to:

PEF Retirees

1168-70 Troy Schenectady Road  P O Box 12414  Albany  New York 12212-2414