Artrs Change Of Address Form

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Form # 6a
Revised 7/2012
1400 West Third, Little Rock, AR 72201
Phone (501) 682-1517 or (800) 666-2877
Fax (501) 682-2359
Website -
Change of Address Form
(Please Print)
Member’s Name ______________________________________________________
Social Security Number _______________________
Employer __________________________________
Telephone Number (______)_________________ Alternate Number (_____)_______________
E-mail Address (optional)_________________________________________________________
Old Mailing Address __________________________________________________________
City ______________________________________ State _________ Zip _______________
New Mailing Address _________________________________________________________
City ______________________________________ State _________ Zip _______________
County ____________________________________
Member’s Signature ________________________________________ Date _____________

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