CHANGE OF ADDRESS FORM

 
To: Watertown Retirement Board
P.O. Box 199, 149 Main Street
Watertown, MA 02471-0199

 
Please be advised that effective my new address is/will be:                                               (Date)

Street


Apartment or P.O. Box #


 City/State/Zip


 Telephone number-10 Digit

 
Please change your records accordingly. Thank you.
Name:
Signature: ________________________________________
Date: ______________
Miscellaneous Information: