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Office of the New York State Comptrofier Received Date Recertification of the SNYSLRS New. York State. and Local Retirement System Record of Activities 110 State Street, Albany, New York 12244-0003 Please type or print clearly in blue or black ink RS 2419 Rev. 09/18) NYSLRS ID Social Security Number fast 4 digits] Retirement System [check one] (Rev 08/48) alee (elelele ole XXX-XX- lal @/@ Employees’ Retirement System (ERS) Police and Fire’ Retirement System (PFRS) [1 | Traci Hopkins , certifythat | completed a 3-month record of activities for the term that began 12/02/2024 for my position as Treasurer | attest that the record of activities maintained for the above named tem is still representative of my hours worked and that my responsibilities have not substantially or rnaterially changed. My current term begins on 94/01/2026 and ends on 04/01/2027 uh lop )ci S 4/21/2026 Signature of Member Date Employer Location Code; 40183 NOTE: A record of activities and any certification based upon such record shall not be valid for more than eight years from the date of the taking of office for which the record of activities was initially maintained. ; Please keep this form on file in your records.and submit a copy to NYSLRS only upon request. CANA