Date of Retirement:
STATE EMPLOYEES RETIREMENT COMMISSION
PROOF OF BIRTH
|STATE OF CONNECTICUT||)|
______________________________________ being duly sworn, deposes and says:
Subscribed and sworn to
before me this ________________
day of ___________________ 19 ____ .
Commissioner of the Superior Court
In addition to the completed affidavit, you must submit two (2) documents, as described on the instruction sheet provided to you, which support your claim of your exact birthdate.
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