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SAN DIEGO COUNTY EMPLOYEES RETIREMENT ASSOCIATION
Strength. Service. Commitment.
Request for Retirement Income Verification or
Member Contributions Verification Letter
MEMBER INFORMATION
First name
MI
Last name
Social Security number (last four)
XXX-XXBirth date
Mailing address
//
City
State
ZIP
Daytime telephone number
DELIVERY INSTRUCTIONS
I am requesting a (check one):
m
m
Retirement Income Verification letter
m
Mail to the above address.
m
Mail to this address:
Member Contributions Verification letter
Full name
Mailing address
CityStateZIP
m
Fax to:
Attention:
AUTHORIZATION
By submitting this form to SDCERA, I hereby authorize SDCERA to release my retirement income or member contributions
information in the form of a Retirement Income Verification or Member Contributions Verification letter. This authorization is
effective for this request only and will produce one letter.
Member’s signature X
Date
Return this completed form to SDCERA at the address below.
2275 Rio Bonito Way, Suite 200 San Diego, CA 92108-1685
Call Center 619.515.6800 or 888.4.SDCERA www.sdcera.org
For office use only Rev. 3/2012