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Park Employees' Annuity and Benefit Fund

of Chicago

Full Name: Social Security Number: Current Address: City: State: Zip: Work Phone: Home Phone: Birthdate: ********************************************** In this section Delete whatever DOES NOT apply.   Marital Status:  Single or Married   Participate in the CPD Deferred Compensation Plan:  Y    N   (Circle one)                             Estimates:   Calculate With Preentry   Calculate Without Preentry   Calculate Preentry Only   Calculate Preentry/Transfers   Calculate Refund Repayments   Calculate Cost of Certified Additional Service *********************************************** Proposed Retirement Date:         or Desired Years of Service to Retirement: Additional Comments: