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CORRECTIONS OFFICER RETIREMENT PLAN 3010 E. Camelback Rd., Suite 200, Phoenix, AZ 85016 (602) 255-5575 FAX (602) 296-2369 www.psprs.com FORM C5-EE Page 1 of 2 08/11 APPLICATION FOR DISABILITY RETIREMENT

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Form C5 - Application is a document that is used to apply for a specific purpose.

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