Member`s Change of Address Form (code DM13)

MEMBER’S CHANGE OF ADDRESS FORM
INSTRUCTIONS
PLEASE READ CAREFULLY
• This form (or online equivalent) should be filed only by TRS in-service members and retirees.
Beneficiaries who are receiving monthly benefit payments should instead file the “Beneficiary’s
Change of Address Form” (code DM14). This paper form may be obtained by accessing our website.
• Upon receipt of this form, TRS will update its records with your new permanent home address
and/or other contact information. TRS will direct all future communications to the home address
and/or other contact information that you indicate in “Part B” of this form. TRS will send you a
written confirmation of all changes.
• A
s an alternative to filing this form, you may update your permanent home address and/or other contact
information by accessing our website. Any updated information that you provide to TRS through our
website will take effect immediately. TRS will send you a written confirmation of all changes.
In Part A: All information must be provided.
In Part B: You may update your new current home address and/or other contact information.
In Part C: You must sign and date this form.
DM13 (11/15) CONTINUED ON PAGE 2
PAGE 1
MEMBER’S CHANGE OF ADDRESS FORM
Please read the instructions on the reverse side before completing this form.
(NOTE: Please print in black or blue ink, and initial any changes that you make on this form.)
PART A: All information must be provided. If information is preprinted below, it represents the address and/or phone number
that TRS currently has on file for you. If information is not preprinted below, please provide your previous address and primary
phone number.
First Name MI Last Name Previous Home Address
City
State
Country
Email Address
Social Security Number (last 4 digits only)
XX X X X
Apt. No. TRS Membership/Retirement Number
Zip Code
Primary Phone Number
()
(Check one:
Home
Work
Mobile)
PART B: Please enter all new information about your current address and other contact information below.
New Permanent Home Address
Apt. No.
City
State
Zip Code
Country
Email Address
Primary Phone Number (Check one:
()
Alternate Phone Number (Check one:
()
Home
Home
Work
Work
Mobile)
Mobile)
We will update our records based on the information you provide above, so do not enter a temporary address; instead, TRS suggests
that you consult the U.S. Postal Service about having your mail forwarded on a temporary basis.
PART C: Please read the following statement and sign and date below.
I certify that the home address and/or other contact information indicated in Part B of this form is/will be my new permanent home
address and/or other contact information. I understand that TRS will direct future communications to this home address and/or other
contact information. I understand that the updated information that I have provided on this form will remain in TRS’ records until
superseded by my filing of subsequent changes with TRS. I affirm that, to the best of my knowledge, all information I have provided
above is true and correct.
MEMBER’S SIGNATURE _______________________________________________________ DATE (M/D/Y) __________________
DM13 (11/15) PAGE 2