The process of changing one’s name officially often requires navigating through several administrative procedures, one of which involves updating personal records with various entities that hold your data. For members of the New York City Employees' Retirement System (NYCERS), this process involves filling out and submitting the F291 Name Change Affidavit. This specific application is designed for individuals who seek to align their updated names with the records maintained by NYCERS. To successfully process a name change, applicants must present legitimate proof of their name alteration, which could come in the form of a court order, marriage certificate, or divorce decree. It is vital to complete this form accurately and provide all necessary documentation to avoid any delays. The F291 form includes sections for the member or pension number, the last four digits of the applicant's Social Security Number, contact information, and, crucially, the details of the name change including a section requiring notarization. For assistance, NYCERS has made available a Call Center reachable at 347-643-3000. The form itself underlines the importance of having it duly acknowledged before a Notary Public or Commissioner of Deeds, ensuring that the name change request is handled with the seriousness and official capacity it demands.
| Question | Answer |
|---|---|
| Form Name | Nycers Form F291 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | nycers form f361, Expiration, Notary, applicable |
NYCERS USE ONLY |
F291 |
|
*291*
Name Change Affidavit
This application is for members who wish to change their name that NYCERS has on file. It is important to provide proof of name change, such as a court order, a copy of a marriage certificate or divorce papers, in order for your application to be processed. Should you have any questions regarding this application, please contact our Call Center at
Member Number |
OR |
Pension Number |
|
Last 4 Digits of SSN |
Daytime Phone |
||
|
|
|
|
|
|
( |
) |
|
|
|
|
|
|
|
|
First Name |
|
|
M.I. |
Last Name |
|
|
|
|
|
|
|
|
|
|
|
in Care of (if applicable)
|
|
|
|
|
Address |
|
Apt. Number |
|
|
|
|
|
|
|
City |
State |
|
Zip Code |
|
|
|
|
|
|
To NYCERS
I, the undersigned, am employed in the Department of _________________________________ or retired from service on
[MM/DD/YYYY]
/ /
I request that my name be changed on NYCERS records from:
First Name |
|
|
|
M.I. |
Last Name |
|
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TO |
|
|
|
|
|
|
|
|
|
|
|
|
|
First Name |
|
|
|
M.I. |
Last Name |
|
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Signature of Member |
|
|
|
|
|
|
Date |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
This form must be acknowledged before a Notary Public or Commissioner of Deeds |
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
State of |
|
County of |
|
|
|
On this |
|
day of |
|
|
2 0 |
|
, personally appeared |
before me the above named, |
|
|
|
|
|
|
, to me known, and known to |
||||||
me to be the individual described in and who executed the foregoing instrument, and he or she acknowledged to me that he or she executed the same, and that the statements contained therein are true.
Signature of Notary Public or Commissioner of Deeds
Official Title
Expiration Date of Commission
Sign this form and have it notarized, THIS PAGE
R06/30/11 |
Page 1 of 1 |