Form Ad-349 - Employee Address - U.s. Department Of Agriculture

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AGENCY USE
FORM AD-349
U.S. DEPARTMENT OF AGRICULTURE
(REV. 12/93)
EMPLOYEE ADDRESS
ACTION
AGENCY
EFFECTIVE
CODE
DATE
SECTION I
Complete Section I with your current or new residence mailing address. This address is used to
mail out employee Pay and TSP statements, W-2 forms and other personal documents.
NOTE: This form does not change the U.S. Savings Bond address.
1. NAME (Last, First, Middle)
2. SOCIAL SECURITY NO.
3. STREET ADDRESS OR P.O. BOX
4. APT NO.
5. CITY NAME
6. STATE or COUNTRY NAME
7. ZIP CODE
AGENCY USE
CITY CODE
COUNTY CODE
STATE OR COUNTRY CODE
SECTION II
FOR EMPLOYEES WITH DIRECT DEPOSIT COMPLETE BLOCKS 13 AND 14 ONLY.
Employees who wish to receive their checks in the mail complete blocks 8 through 14 with
your current or new check mailing address.
8. STREET ADDRESS or P.O. BOX
9. APT NO.
10. CITY NAME
11. STATE or COUNTRY NAME
12. ZIP CODE
AGENCY USE
CITY CODE
COUNTY CODE
STATE OR COUNTRY CODE
13. SIGNATURE OF EMPLOYEE
14. DATE SIGNED
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