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 Form C







Benefits Examiner

Teachers Retirement System

10 Corporate Woods Drive

Albany, New York 12211


Dear                                  :

Would you please provide me with the Final Average Salary and the
Retirement Allowance without Option for the following SUNY retiree:


Name                         Social Security No.             Retirement Date




If you need any additional information, please let me know. My telephone
number is                                              and fax number is

Thanks once again for your assistance.