This form must be completed by every new member. The form may be provided by the employer.
Member Information Changes
Change of Name and/or Address Form
This form allows working and terminated vested members to update home addresses.
Primary Change of Beneficiary
This form allows a member to change the primary beneficiary they elected at their time of employment.
Secondary Change of Beneficiary
This form allows a member to change the secondary beneficiary they elected at their time of employment.
Disability Application Packets
Ordinary Disability Application
This packet contains everything needed to file for non-work-related disability retirement if you have sufficient service to apply.
Work Related Disability Application
This packet contains everything needed to file for disability retirement if you become permanently incapacitated while on the job.
IRS Form W-4P for 2021
Use this form to change the amount withheld from monthly pension benefits for Federal Income Tax purposes.
Chapter 218:12 VI 2021 Worksheet
Complete this worksheet annually to determine your IRS contribution limit for Optional Service Purchases.
Chapter 218:9 III 2021 Worksheet
Complete this worksheet annually to determine your IRS contribution limit for Additional Contributions.
Report a Violation
Compliance Report Form
Use this “Whistle Blower” form to report any suspected wrongdoing by Retirement Staff or Trustees.
2021 Additional Contribution Packet
This packet contains everything you need to enroll in the voluntary “Additional Contribution “ program.
Additional Contribution Deposit Form
Use this form to make a one-time lump sum deposit to your previously established Additional Contribution account.
Additional Contribution Deduction Change
Use this form to change or stop weekly payroll deductions for Additional Contributions.
Refund Application – Direct Rollover Form
Contains everything needed to close your account if after leaving employment when not planning to collect a lifetime monthly retirement […]
Election to Vest Benefits After Termination – More Than 5 Years of Service
For those who have left employment after more than 5 years and wish to leave their funds in the Plan.