State of Connecticut Office of the State Comptroller 2003 EARLY RETIREMENT INCENTIVE PROGRAM memo Attachment G

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:

1910/1920/1930/1940 Census Record (Department of Commerce, Bureau of Census, Washington, D.C.)
Religious Record
Insurance Record
Early School Record
Military Record
Passport
Naturalization Papers
Letter from Social Security stating date of birth
Hospital record

Please send the completed affidavit and the documents to:

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

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