Essex Regional Retirement Board
Serving those who serve others for the greater good.

Address Change Form

Please, complete the following for your old address

Name on our records
Social Security Number
Street Address
City
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Zip code

Phone number
Email address

Please record new address information below:

If your name has changed, you will need to forward us a copy of the legal document stating the change. i.e. marriage certificate, divorce decree, change of name certificate, et cetera

Your Full New Name
New Street Address
New City
Pick your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming       New State
New Zip code

New Phone Number
New Email Address

Is this permanent? Or are you a snow bird? Please check one:

Permanent Temporary (Winter/Summer)

By selecting below, you are agreeing that this information is accurate and that you are the person responsible for this pension account.

I Agree I Disagree

Comments? If this is a temporary change, please inform us of when each address is appropriate. We send important documentation throughout the year so please be sure to keep us up to date.

To submit this form, please enter the characters you see in the image:

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