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Form Trf-3 Request For Direct Transfer Of Membership - New York State Teachers' Retirement System

TRF-3 (2/10)

OFFICE SERVICES ONLY

NEW YORK STATE TEACHERS’ RETIREMENT SYSTEM

10 Corporate Woods Drive, Albany, NY 12211-2395

REQUEST FOR DIRECT

TRANSFER OF MEMBERSHIP

Please be advised that I am registered in another New York State public retirement system and request the

transfer of my membership in the New York State Teachers’ Retirement System, to the

Name of Retirement System ____________________________________________________________________________

NAME

SOCIAL SECURITY NUMBER

(Last)

(First)

(Middle)

ADDRESS

EMPLID

(Street)

DATE OF BIRTH

(City)

(State)

(Zip Code)

PHONE

(

)

NUMBER

Is this address your PERMANENT address to be used by the System?

Yes

Have you taught in a New York State public school, other than New York City, during the current school year?

YES

If yes, please list the school district(s):

DATE CEASED TEACHING IN NYS PUBLIC SCHOOLS (OUTSIDE NYC): ______________________________

Title of new position: _____________________________________________ Starting Date _____________________

in the _______________________________________________________________________________________________

(Name of Department, School or Other Unit Where Employed)

_________________________________________________

(Signature)

Form Trf-3 Request For Direct Transfer Of Membership - New York State Teachers' Retirement System