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Revised 2/17 CHANGE OF PERSONAL INFORMATION FORM This form is for members who have not yet retired and are not collecting benefits from PERS to change, update or correct account information. Name: SSN: If name has changed, please list previous name(s): Gender: M F Birth Date: Marital Status: Single Married Widowed Current Address: (Members who have not retired may also change their address online at our website) Home Phone: Work Phone: Personal Email: This form updates personal information only and does not change beneficiaries listed on your Survivor Beneficiary Designation Form. Signature: Date: For PERS Use – Date Stamp Public Employees’ Retirement System of Nevada 693 W. Nye Lane, Carson City, NV 89703 (775) 687-4200 Fax (775) 687-5131 5740 S. Eastern Ave. Suite 120, Las Vegas, NV 89119 (702) 486-3900 Fax (702) 678-6934 Toll Free 1-[PHONE REDACTED] Website: www.nvpers.org Email: [EMAIL REDACTED]