CitiStreet P.O. Box 5166 Oregon Savings Growth Plan Boston, MA

ADDRESS/NAME CH ANGE FORM
Actively deferring State employees must submit address/name change information through agency payroll and human resource
departments and should not use this form. All other participants should provide the requested information below and mail
as directed.
PLEASE CH ANGE MY ADDRE SS/ NAME AS FOLLOWS:
PLEASE PRINT
Name
Address
OLD
City, State, Zip
Name
Address
NEW
City, State, Zip
X
Participant s Signature (Do not print)
Social Security Number
Date
Telephone Number
(This form must be signed by the participant in order to be processed.)
Mail this form to:
CitiStreet
ING
Oregon
Growth
Plan
GrowthPlan
Plan
Oregon Savings
Savings Growth
800
Street NE Ste 200
P.O.
Box
P.O. Summer
Box 5166
24747
Boston,
MA97301
02206
Salem
OR
Jacksonville,
FL 32241-4747
Please review this form and keep a copy for your records. Call the Oregon Savings Growth Plan Information Line at
800-365-8494 if you have any questions. Customer Service Representatives are available Monday through Friday, between 7:007:0
and
except
onime,
New
holidays.
0
a.a.m.a.m.
m. and
and 5:00
5:00
5p.m.
:00 pPacific
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acificcific
Time,
exYork
cept Stock
onon NExchange
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Stock ExExchangechange hoholilidadayys.s.
7:00
800 Summer Street N.E., Suite 200, Salem, OR 97301
Voice: (503) 378-3730
Fax: (503) 378-5888
TTY: (503) 378-4942
osgp.ingplans.com
SL3
ADD_ING_OR 0309