Member Birth Date	Year Month January February March April May June July August September October November December
Designated Survivor Birth Date	Year Month January February March April May June July August September October November December
Credited Class of Service	Class of Service AA-50AA-60 Other
Anticipated Retirement Date	Year Month January February March April May June July August September October November December
Enter the following as of December 31st, last year.
State Service
Non-State Service
Total Service (State + Non-State)
Final Average Salary
Retirement Covered Earnings
Account Balance Total Deductions