INSTRUCTIONS: ARIZONA AUTHORIZATION FOR RELEASE OF INFORMATION

To permit the Arizona retirement funds for public safety personnel, corrections officers or elected officials to release your Social Security number to the Internal Revenue Service, you must file the document discussed in this article. This authorization form can be obtained from the website maintained by the Public Safety Personnel Retirement System.

Arizona Authorization For Release Of Information Step 1: In the first box of section 1, enter your Social Security number. You have the option of only entering the last four digits of your Social Security number.

Arizona Authorization For Release Of Information Step 2: Enter your SYSID, if known, in the second box.

Arizona Authorization For Release Of Information Step 3: In the third box, indicate with a check mark whether you are retired, non-retired or a survivor/guardian.

Arizona Authorization For Release Of Information Step 4: Enter your last name in the fourth box, your first name in the fifth box, and your first name in the sixth box.

Arizona Authorization For Release Of Information Step 5: Enter your full address in the seventh box.

Arizona Authorization For Release Of Information Step 6: Enter your email address in the eighth box.

Arizona Authorization For Release Of Information Step 7: Enter your home telephone number in the ninth box, your cell phone number in the tenth box, and your work phone number in the eleventh box.

Arizona Authorization For Release Of Information Step 8: In the first box of Section 2, enter the name of the person or organization representative to whom you are authorizing the release of this information.

Arizona Authorization For Release Of Information Step 9: In the second box, enter their email address.

Arizona Authorization For Release Of Information Step 10: In the third box, enter the name of the organization.

Arizona Authorization For Release Of Information Step 11: In the fourth box, enter the street address of the person or organization.

Arizona Authorization For Release Of Information Step 12: In the fifth box, enter their telephone number.

Arizona Authorization For Release Of Information Step 13: In the sixth box, enter their fax number.

Arizona Authorization For Release Of Information Step 14: Sign the first box in section 4.

Arizona Authorization For Release Of Information Step 15: Enter the date in the second box of section 4.