Standard Form 2807 July 1980 FPM Supplement 831-1
Register of Separations and Transfers
Civil Service Retirement System
Date
7540-00-634-4259 Previous editions not usable.
Agency
Page No.
Bureau or Reporting Unit
Location
Payroll Office No.*
Name and Date of Birth (1)
Current Year Retirement Deductions (for agency use only) (2)
Total Retirement Deductions to Credit of Employees (3)
Date of Separation and Remarks, if any (4)
Page Totals Totals Brought Forward from Page _____ Accumulated Totals to Date Instructions:
$0.00
$0.00
$0.00
$0.00
One copy of this register must accompany 2806's transmitted to the Office of Personnel Management and one copy sent to agency retirement officer by bureau or reporting unit.
*Give payroll office number of submitting office.
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