Change of Address Form

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: