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Verification of Receipt of Annuity Payment

Monday, June 23, 2014

Important: This document is only to be used in response to a request from DCRB to complete the information. The intent of the form is to confirm that the annuitant is receiving a monthly annuity amount and requires that the form be signed in the presence of a Notary Public.

Requests to third parties to verify monthly income require the Authorization for Release of Confidential Information form to be completed.