(Please Print)
To: Wellesley Retirement Board
525 Washington Street
3rd Floor
Wellesley, MA 02484
Please be advised that as of ___________________ my new address is/will be:
Street: _____________________________________________
Apt. #/P.O. Box:______________________________________
City/Town:__________________________________________
Please Change my records accordingly. Thank you.
Name:_____________________________________________
Signature: _________________________________________
Date:______________________________________________
Additional Comments:
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