State of Connecticut

Attachment "B" 

Person Designated as Agency Contact for Information on
2003 Early Retirement Incentive Program Workshops

Please return to: State Comptroller
Retirement & Benefit Services Division
55 Elm Street
Hartford, CT 06106
Att: Patricia Meskers
Fax: 702-3489

Agency Name:

Agency Address:


This agency has designated the following staff member to handle reservations for our employees who are eligible for the early retirement incentive program and who wish to attend one of the scheduled workshops.

Designated Contact's Name:


Telephone Number:

Fax Number:

Authorized Agency Signature



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