Public Employees’ Retirement System of Nevada
693 W. Nye Lane, Carson City, NV 89703 (775) 687-4200 Fax (775) 687-5131
5740 S. Eastern Ave. Suite 120, Las Vegas, NV 89119 (702) 486-3900 Fax (702) 678-6934
Toll Free 1-866-473-7768 Website:
Proof of Birth Date and Name Change Documentation
Your retirement benefit is based on the ages of you and your beneficiary, if applicable. Therefore,
when you retire, we require documentation of both you and your beneficiary’s date of birth and any
name changes. Please submit legible photocopies of your documents with your name and social
security number written on each document.
Proof of Birth Date Documentation
Any one of the following may be used to establish birth date for you and your beneficiary.
If your current name is different from what is listed on these documents, refer to the Name
Change Documentation section of this form.
A birth certificate
An infant baptism certificate
A delayed certificate of birth
Name Change Documentation
Any of the following may be used to document name changes for you and your beneficiary.
Divorce papers, only if the document restores your name back to your previous or maiden
A driver's license, if your maiden name is also listed
A child’s birth certificate, if your maiden name is shown
Any two of the following documents may be used to establish birth date and/or name change
in lieu of the above categories. Please note that if your current name and date of birth
are listed on both documents, these two documents together will satisfy our birth date
and name change documentation requirements.
School age records
Military service records
A marriage record, if your birth date is shown
A Naturalization certificate, if your age is shown
A transcript of record from U.S. Bureau of Census
Family records in the family Bible
Motor vehicle records
A Social Security estimate (Your Social Security Card does not list your birth date.)
Voter registration records
Any document over ten years old if birth date is shown
A notarized statement from a relative, who was an adult at the time of your birth,
certifying your birth name and birth date
PERS Shared Files\PERS' Forms/ POB list.doc