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Fillable EMPLOYEES' RETIREMENT SYSTEM OF - ersri

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EMPLOYEES' RETIREMENT SYSTEM OF RHODE ISLAND st 40 Fountain Street, 1 Floor Providence, RI 02903 ­ 1854 Office (401) 457-3900, Fax (401) 222-2430 Email: ersri@ersri.org Web Site: www.ersri.org APPLICATION FOR REFUND OF ACCUMULATED CONTRIBUTIONS TO MEMBER Instructions: Please print or type in black ink. See reverse side for additional information. RETIREMENT PLAN (CHECK ONE) State/Teachers Municipality State...
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