State of Connecticut

Attachment "G" 

INSTRUCTION SHEET FOR EMPLOYEE RELATING TO DATE OF BIRTH

TO: Current Date:
Date of Retirement:

In the event that you cannot obtain your birth certificate or certification of birth from a State Health Department, you must comply with the following:

1. Execute the attached affidavit, and

2. Supply the Retirement & Benefit Services Division with two of the following documents which reference your date of birth:

  1. 1910/1920/1930/1940 Census Record (Department of Commerce, Bureau of Census, Washington, D.C.)
  2. Religious Record
  3. Insurance Record
  4. Early School Record
  5. Military Record
  6. Passport
  7. Naturalization Papers
  8. Letter from Social Security stating date of birth
  9. Hospital record

Please send the completed affidavit and the documents to:

Retirement & Benefit Services Division
Attention: Audit Unit
55 Elm Street
Hartford, CT 06106

Return to 2003 ERIP memo

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