Address Change Notification Retirement Systems of Alabama PO Box 302150, Montgomery, Alabama 36130-2150 877.517.0020 • 334.517.7000 • www.rsa-al.gov Your SSN *RSA ADDCHGF//1/* Check One: q ERS q TRS q JRF q Non-RSA members who only have an RSA-1 account Your New Information Name___________________________________________________________________________________________ First Middle/Maiden Last This will change your home address with Address__________________________________________________________________________________________ Street or P.O. Box City State ZIP Code ALL RSA accounts and any distribution Daytime Telephone____________________________ Email Address__________________________________________ ( ) payments that are mailed to your home Date of Birth ________________________________ address. Effective Date of New Address_____________________________ (Month/Day/Year) Previous Address Information Previous Address___________________________________________________________________________________ Street or P.O. Box City State ZIP Code Previous Telephone____________________________ Previous Email Address____________________________________ ( ) Sign Here è Your Signature ______________________________________________________ Date ___________________ Note: You can also change your address online through Member Online Services at https://mso.rsa-al.gov. For expedited address change, fax to 877.517.0021 RSA ADDCHGF REV 6-16