Form 1-C, Enrollment Blank

INSTRUCTIONS: ALABAMA ENROLLMENT BLANK (Form JRF 1-C)

Alabama judicial branch judges and justices are generally required to enroll in the state-administered Judicial Retirement Fund must submit a form JRF 1-C. The Judicial Retirement Fund is a defined benefit plan which falls under section 401(a) of the federal internal revenue code. This document can be found on the website of the Retirement Systems of Alabama.

Alabama Enrollment Blank JRF 1-C Step 1: On the first line, print your first, middle and last name.

Alabama Enrollment Blank JRF 1-C Step 2: On the second line, print your complete home address.

Alabama Enrollment Blank JRF 1-C Step 3: On the third line, print your date of birth.

Alabama Enrollment Blank JRF 1-C Step 4: On the fourth line, print your sex.

Alabama Enrollment Blank JRF 1-C Step 5: On the fifth line, print your Social Security number.

Alabama Enrollment Blank JRF 1-C Step 6: On the sixth line, print the title of your current judicial position.

Alabama Enrollment Blank JRF 1-C Step 7: On the seventh line, print your circuit or county location.

Alabama Enrollment Blank JRF 1-C Step 8: On the eighth line, enter the date on which your service in your current capacity began.

Alabama Enrollment Blank JRF 1-C Step 9: On the ninth line, enter your annual salary from the state treasury.

Alabama Enrollment Blank JRF 1-C Step 10: If a probate judge, enter your salary on the tenth line. If you are not paid on a salaried basis, circle "Fees."

Alabama Enrollment Blank JRF 1-C Step 11: On the eleventh line, enter the name of your spouse.

Alabama Enrollment Blank JRF 1-C Step 12: On the twelfth line, enter the sex of your spouse.

Alabama Enrollment Blank JRF 1-C Step 13: On the thirteenth line, enter the date of birth of your spouse.

Alabama Enrollment Blank JRF 1-C Step 14: On the fourteenth line, enter the Social Security number of your spouse.

Alabama Enrollment Blank JRF 1-C Step 15: Sign the form in the presence of a notary public, who will also sign and date the form and affix their seal.

Alabama Enrollment Blank JRF 1-C Step 16: Send the form to the Judicial Retirement Fund of Alabama at the address given at the top of the form.

Beneficiary Designation

INSTRUCTIONS: ALABAMA BENEFICIARY DESIGNATION RSA-1 AND PEIRAF

Alabama public employees enrolled in either the RSA-1 or PEIRAF retirement funds should file a beneficiary designation to appoint beneficiaries to whom funds will be disbursed in the event of their death. This beneficiary designation form can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 1: At the top left-hand corner, indicate with a check mark whether you are enrolled in the RSA-1 or PEIRAF program.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 2: On the first blank line, enter your first name, middle or maiden name and last name.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 3; On the second blank line, enter your street address or PO box number.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 4: On the third blank line, enter your city, state and zip code.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 5: On the fourth blank line, enter your Social Security number.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 6: On the fifth blank line, enter your phone number.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 7; If you are including beneficiary information on both sides of the page, check the line stating so.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 8: The first section allows you to name up to three primary beneficiaries who will receive your benefits providing they survive you. The format for naming each beneficiary. In the first blank line for each primary beneficiary, enter their name.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 9: In the second blank line for each primary beneficiary, enter their relationship to you.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 10: In the third blank line for each primary beneficiary, enter their date of birth.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 11: In the fourth blank line for each primary beneficiary, enter their Social Security number.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 12: In the fifth blank line for each primary beneficiary, enter their address.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 13: Follow the same format to name all contingent beneficiaries who will inherit in case your primary beneficiaries do not survive you.

Alabama Beneficiary Designation RSA-1 And PEIRAF Step 14: Sign and date the form before a notary public.

Special Catch-Up Election and Worksheet

INSTRUCTIONS: ALABAMA SPECIAL CATCH-UP ELECTION AND WORKSHEET (Form RSA-1 CATCH UP)

Alabama public employees who are enrolled in the RSA-1 retirement fund plan can use an RSA-1 Catch Up worksheet to make catch-up deferrals for years in which they failed to contribute the maximum possible to the retirement fund. This can be done in the three years prior to Normal Retirement Age. This form can be found on the website of the Retirement Systems of Alabama.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 1: At the top of the first page, enter your name, address, Social Security number, phone number, date of birth and email address.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 2: In the next section labeled "Special Catch-Up Election," enter the age you are designating your Normal Retirement Age and the year in which you will be this age.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 3: In the section labeled "Employee Certification," enter the name of your current employer and their address. Sign and date the bottom of this page.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 4: Complete the worksheet on the second and third pages. The first column lists every calendar year from 1986 to 2011. For each year for which you did not pay the maximum deferrable amount, enter your gross income as documented on your W-2 for that year in column B.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 5: Enter the amount contributed to your RSA-1 fund that year in column C.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 6: Subtract column C from column B. Enter the difference in column D.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 7: Consult the instructions for "Step 5" on the page to determine what figure should be entered in column E.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 8: In column F, enter the amount deferred to retirement funds in that year.

Alabama Special Catch-Up Election And Worksheet RSA-1 Catch Up Step 9: Subtract column F from column E. Enter the difference in column G. This determines how much you can make in catch-up payments for that year. Transfer this information to the chart at the bottom of the page.

Form 8: Beneficiary Designation

INSTRUCTIONS: ARIZONA BENEFICIARY DESIGNATION FORM (Form 8)

Arizona public safety personnel, corrections officers, and elected officials enrolled in the state's retirement plan for each type of employee can all use a form 8 to designate primary and secondary beneficiaries in the event of their death. This document can be obtained from the website maintained by the Elected Officials' Retirement Fund of the State of Arizona.

Arizona Beneficiary Designation Form 8 Step 1: Section 1 requires information about the member filing. On the first line, enter your Social Security number, SYSID (if known), and indicate with a check mark whether this request applies to a retired or non-retired account.

Arizona Beneficiary Designation Form 8 Step 2: On the next line, enter your date of birth and email address.

Arizona Beneficiary Designation Form 8 Step 3: On the next line, enter your last name, first name and middle initial.

Arizona Beneficiary Designation Form 8 Step 4: On the next line, enter your street address, city, state and zip code.

Arizona Beneficiary Designation Form 8 Step 5: On the next line, enter your home phone number, cell phone number and work phone number.

Arizona Beneficiary Designation Form 8 Step 6: Section 2 is for designation and documentation of beneficiaries. The first section should only be used to name a primary beneficiary. Enter their Social Security number in the first box.

Arizona Beneficiary Designation Form 8 Step 7: Enter their full name in the second box.

Arizona Beneficiary Designation Form 8 Step 8: Indicate their relationship to you with a check mark in the third box.

Arizona Beneficiary Designation Form 8 Step 9: Enter their birth date in the fourth box.

Arizona Beneficiary Designation Form 8 Step 10: Enter their address in the fifth box.

Arizona Beneficiary Designation Form 8 Step 11: Enter their telephone number in the sixth box.

Arizona Beneficiary Designation Form 8 Step 12: In the next two sections, you may designate up to two more primary or secondary beneficiaries. In each section, indicate with a check mark which of teh two types you are designating, then provide all information requested.

Arizona Beneficiary Designation Form 8 Step 13: A witness who is not a beneficiary should print and sign their name in Section 3, as well as entering the date.

Arizona Beneficiary Designation Form 8 Step 14: Sign and date the last line.

DROP Participation Period Completed – Will Continue Employment

DROP Participation Period Completed - Will Continue Employment

INSTRUCTIONS: ALABAMA DEFERRED RETIREMENT OPTION PLAN (DROP) PARTICIPATION PERIOD COMPLETED/CONTINUED SERVICE (Form ERS 10 D-CCE)

Alabama state employees transferring to another job use a form ERA 10 D-CCE to terminate their enrollment in the state Deferred Retirement Option Plan (DROP). This document can be obtained from the website of the Employees' Retirement System of Alabama.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 1: On the first line, enter your first, middle and last name.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 2: On the second line, enter your Social Security number.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 3: On the third line, enter your employing agency.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 4: On the fourth line, enter your requested DROP termination date. This must be the last day of any given month.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 5: On the fifth line, enter your phone number.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 6: Check the box on line I.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 7: Sign line II in the presence of a notary public.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 8: Part III should be completed by your employer. On the first line, they will enter your last date of service prior to DROP termination.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 9: On the second line, your employer will enter the closing date of the last payroll for salary earned prior to DROP termination.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 10: On the third line, your employer will enter your total accrued unused sick leave days at the end of the DROP participation period.

Alabama Deferred Retirement Option Plan (DROP) Participation Period Completed/Continued Service ERA 10 D-CCE Step 11: An authorized official should sign and date the fourth line, as well as entering the employing institution's name and telephone number.

Applying for DROP Distribution – Early Termination

Applying for DROP Distribution - Early Termination

INSTRUCTIONS: ALABAMA DEFERRED RETIREMENT OPTION PLAN (DROP) REQUEST FOR EARLY TERMINATION OF DROP

Alabama state employees and retirees who are eligible to transfer part of their state retirement plans to an IRA or an employer plan can do so by using the document discussed in this article. This form can be found on the website of the Retirement Systems of Alabama.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 1: Enter your name and Social Security number.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 2: Enter your address.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 3: Enter your work and home telephone numbers.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 4: Enter your employing agency.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 5: Enter the requested effective date of your DROP termination.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 6: Enter your date of birth.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 7: In response to part I, indicate with a check mark why you are requesting an early termination of your DROP.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 8: In part II, indicate your wishes regarding withholding from pension or annuity payments.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 9: Only complete part III if your employing agency permits the conversion of sick leave days to retirement credits.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 10: Sign the form in Part IV.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 11: A notary public should sign the form and affix their seal.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 12: The employer should complete Part V.

Alabama Deferred Retirement Option Plan (DROP) Request For Early Termination Of DROP Step 13: This packet also provides a form authorizing the continuation of state health insurance, as well as one allowing you to elect to take rollover distribution and one authorizing direct deposits of your refund.

RSA 100-C Change of Beneficiary Prior to Retirement Form

INSTRUCTIONS: ALABAMA CHANGE OF BENEFICIARY FORM PRIOR TO RETIREMENT (Form RSA 100-C)

Prior to your retirement, if you wish to change the beneficiaries who will receive the accumulated credits from your contributions to your Alabama retirement fund as a state employee in the event of your death, you may do so by filing a form RSA 100-C. This document can be obtained from the website of the Retirement Systems of Alabama. Print or type your answers in black ink. Note that this form should not be used by those who are retired or participants in the DROP program.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 1: Enter your name and Social Security number.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 2: Enter your date of birth.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 3: Enter your home phone number.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 4: Indicate with a check mark if you are an active or inactive member.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 5: The section below is where you name your primary beneficiary. On the first line there, give their name.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 6: On the second line, state their relationship to you.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 7: On the third line, give their date of birth.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 8: On the fourth line, enter their Social Security number.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 9: On the fifth line, give their full address.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 10: You may name additional primary beneficiaries on the second page.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 11: The next section allows you to name a contingent beneficiary in the event that all of your primary beneficiaries are deceased. Provide their name, relationship to you, date of birth, Social Security number and address.

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 12: You must sign and date the form in the presence of a notary public.

Form RSA PUR TRAN Purchase Transfer Request

INSTRUCTIONS: ALABAMA PURCHASE TRANSFER REQUEST (Form RSA PUR TRAN)

If electing to transfer funds from a qualified and tax-deferred fund for the purchase of service in the Alabama Employees' Retirement System or Teachers' Retirement System of Alabama, you should file the form discussed in this article. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Purchase Transfer Request RSA PUR TRAN Step 1: Part I concerns the member. Indicate with a check mark whether you are a member of the Employees' Retirement System or Teachers' Retirement System.

Alabama Purchase Transfer Request RSA PUR TRAN Step 2: Enter your Social Security number on the first blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 3: Enter your account number on the second blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 4: Enter your name on the third blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 5: Enter your date of birth on the fourth blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 6: Enter your address on the fifth blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 7: Enter your home telephone number on the sixth blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 8: Enter your work telephone number on the seventh blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 9: Enter the amount of the transfer requested on the eighth blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 10: Enter your signature on the ninth blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 11: Enter the date on the tenth blank line.

Alabama Purchase Transfer Request RSA PUR TRAN Step 12: Have the form certified by a notary public.

Alabama Purchase Transfer Request RSA PUR TRAN Step 13: Part II concerns the retirement plan and should be completed by a representative of the plan. They should indicate the type of plan with a check mark.

Alabama Purchase Transfer Request RSA PUR TRAN Step 14: On the next two blank lines, the representative should enter the name of the company transferring the funds and your account number.

Alabama Purchase Transfer Request RSA PUR TRAN Step 15: The plan representative should provide all other requested information, then sign and date the form.

Form RSA DROP BEN Applying for Beneficiary Payment DROP

INSTRUCTIONS: APPLICATION FOR BENEFICIARY PAYMENT DEFERRED RETIREMENT OPTION PLAN (Form RSA DROP BEN)

Spousal and non-spousal beneficiaries can apply for payments designated for them from an Alabama Deferred Retirement Option Plan (DROP) by filing the form discussed in this article. This document can be obtained from the website of the Retirement Systems of Alabama.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 1: Part I concerns the member and beneficiary. On the first blank line, enter the full name of the deceased member.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 2: On the second blank line, enter the Social Security number of the deceased member.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 3: On the third blank line, enter the date of birth of the deceased member.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 4: On the fourth blank line, enter the date of death of the deceased member.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 5: On the fifth blank line, enter the employing agency of the deceased member.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 6: On the sixth blank line, enter the full name of the beneficiary.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 7: On the seventh blank line, enter the beneficiary's date of birth.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 8: On the eighth blank line, enter the beneficiary's relationship to the deceased member.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 9: On the ninth blank line, enter the beneficiary's Social Security number.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 10: Enter the beneficiary's telephone number on the tenth blank line.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 11: Enter the beneficiary's address on the eleventh blank line.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 12: Part II concerns distribution options for spousal and non-spousal beneficiaries. Complete this section as directed.

Application For Beneficiary Payment Deferred Retirement Option Plan RSA DROP BEN Step 13: Sign and date Part III. Obtain the certification of a notary public. Your employer should complete Part IV.

Form RSA-1 IOE DROP or TRANSFER Annual Investment Option Election for DROP Rollover or 457 Transfer RSA-1 Deferred Compensation Plan

INSTRUCTIONS: ALABAMA ANNUAL INVESTMENT OPTION ELECTION DROP ROLLOVER OR 457 TRANSFER (Form RSA-1 IOE)

Alabama public employees enrolled in the state-administered RSA-1 delayed compensation retirement fund can use a form RSA-1 IOE to elect a DROP rollover or 457 transfer. This document can be obtained from the website of the Retirement Systems of Alabama.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 1: Enter your first name, middle or maiden name and last name on the first blank line.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 2: Enter your Social Security number on the second blank line.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 3: Enter your date of birth on the third blank line.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 4: If the member is deceased, enter the first name, middle name or maiden name and last name of the beneficiary on the fourth blank line, their Social Security number on the fifth blank line and their date of birth on the sixth blank line.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 5: On the next blank line, enter your street address or P.O. box number.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 6: On the next blank line, enter your city, state or zip code.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 7: On the next blank line, enter your email address.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 8: On the next blank line, enter your telephone number, including the area code.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 9: Indicate the type of election you are requesting by placing a check mark next to the appropriate statement.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 10: Enter the signature of the member or the beneficiary if the member is deceased on the next blank line and the date on the last blank line.

Alabama Annual Investment Option Election Drop Rollover Or 457 Transfer RSA-1 IOE Step 11: Have the form certified and signed by a notary public.

Retirement

Judicial Retirement System

Firefighter Certification