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Annual Investment Option Election for DROP Rollover or 457 Transfer

Annual Investment Option Election for DROP Rollover or 457 Transfer

 

INSTRUCTIONS: ALABAMA ANNUAL INVESTMENT OPTION ELECTION DROP ROLLOVER OR 457 TRANSFER (Form RSA-1 IOE)
 
Alabama public employees enrolled in the DROP or section 457 retirement plans can use a form RSA-1 IOE to annually declare how much they wish of their funds to be invested in fixed or stock investment options. 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: Indicate with a check mark whether you are performing a DROP rollover or a 457 transfer.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step 2: On the first blank line, enter your full name.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step 3: On the second blank line, enter your Social Security number.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  4: On the third blank line, enter your date of birth.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  5: If you are the beneficiary of a deceased person, complete the next three lines, Otherwise, leave these blank. 
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  6: Enter your street address, email address and home phone number where indicated.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  7: Check only one of the four listed options regarding your account. Check the box next to the first statement to set a percentage of your fixed investment to be transferred to stocks and write the percentage.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  8: Check the box next to the second statement to set a dollar amount of your fixed investment to be transferred to a stock investment and write the dollar amount.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  9: Check the box next to the third statement to transfer a percentage of your stock investment to a fixed investment option and write the percentage.
 
Alabama Annual Investment Option Election DROP Rollover Or 457 Transfer RSA-1 IOE Step  10: Check the box next to the fourth statement to transfer a dollar amount of your stock investment to a fixed investment and write the amount. 
 

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Public Records Inspection or Reproduction Request Form

Public Records Inspection or Reproduction Request Form

 

INSTRUCTIONS: ARIZONA PUBLIC RECORDS INSPECTION OR REPRODUCTION REQUEST FORM 

 

 

To request an inspection or copies of Arizona public records in the care of the state retirement plans for public safety personnel, corrections officers or elected officials, you may file the form discussed in this document. This form can be obtained from the website maintained by the website of the Public Safety Personnel Retirement System of Arizona.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 1: Check the first box if you are requesting a record inspection without any copies being made.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 2: If you are seeking copies of these documents, check the box next to the applicable statement. Check the first box if requesting paper copies.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 3: Check the second box if requesting computer printouts.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 4: Check the third box if requesting electronic copies.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 5: In the table provided, enter the records you are seeking to inspect or receive copies of.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 6: Check the next box if you are requesting these records for an intended commercial purpose. If so, provide a brief explanation in the box provided. If approved, the charge for these copies will reserve a portion of the cost for the public body which obtained the original documents, as well as including a reasonable fee for the labor and materials involved in reproduction and a fee for the current market value of the reproduction.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 7: Sign your name on the first blank line at the bottom of the page.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 8: Print your name on the second blank line.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 9: Enter your company name on the third blank line.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 10: Enter your street address on the fourth blank line.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 11: Enter your city, state and zip code on the fifth blank line.

 

Arizona Public Records Inspection Or Reproduction Request Form Step 12: Enter your phone number, fax number and email address on the sixth blank line.

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Insurance Authorization

Insurance Authorization

 

INSTRUCTIONS: ALABAMA INSURANCE AUTHORIZATION (Form TRS 12-T)
 
Members of the Teachers' Retirement System of Alabama who wish to have insurance premiums deducted from their retirement benefits do so by filing a form TRS 12-T. This document can be obtained from the website maintained by the Teachers' Retirement System of Alabama.
 
Alabama Insurance Authorization TRS 12-T Step 1: On the first line, enter your first, middle and last name.
 
Alabama Insurance Authorization TRS 12-T Step 2: On the second line, enter your Social Security number.
 
Alabama Insurance Authorization TRS 12-T Step 3: On the third line, enter your full telephone number, including the area code.
 
Alabama Insurance Authorization TRS 12-T Step 4: On the fourth line, enter your P.O. box number or street address.
 
Alabama Insurance Authorization TRS 12-T Step 5: On the fifth line, enter your city, state and zip code.
 
Alabama Insurance Authorization TRS 12-T Step 6: The next section is for documentation of the insurance policies in question. In the first section of the table provided, enter the name of the insurance company in the first box.
 
Alabama Insurance Authorization TRS 12-T Step 7: In the second box, enter the policy number.
 
Alabama Insurance Authorization TRS 12-T Step 8: In the third box, enter the monthly premium paid.
 
Alabama Insurance Authorization TRS 12-T Step 9: In the fourth box, enter the start date for deductions.
 
Alabama Insurance Authorization TRS 12-T Step 10: In the fifth box, enter the insurance company address.
 
Alabama Insurance Authorization TRS 12-T Step 11: Provide the same information for up to three other policies in the rest of the table.
 
Alabama Insurance Authorization TRS 12-T Step 12: Sign and date the form.
 
Alabama Insurance Authorization TRS 12-T Step 13: Give the form to your employer for certification. In the first two blanks, your name will be entered.
 
Alabama Insurance Authorization TRS 12-T Step 14: In the third blank, the date on which the last deduction was performed will be entered.
 
Alabama Insurance Authorization TRS 12-T Step 15: A payroll clerk should sign and date the bottom of the hpage.
 
Alabama Insurance Authorization TRS 12-T Step 16: The form should be submitted to the Teachers' Retirement System of Alabama by your employer via the address provided at the top the top of the page. 
 

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RSA 100-C Change of Beneficiary Form

RSA 100-C Change of Beneficiary Form

 

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

 

 

Alabama public employees who wish to change the beneficiaries of their retirement benefits and state-administered plans do so using a form RSA 100-C. This document can be obtained from the website of the Retirement Systems of Alabama.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 1: All parts of the form must be printed or typed in black ink. The first section, "Member Information," must be completed by all people filing this form. On the first blank line, enter your first name, middle or maiden name and last name.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 2: On the second blank line, enter your Social Security number.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 3: On the third blank line, enter your date of birth.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 4: On the fourth blank line, enter your home telephone number.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 5: Indicate whether you are an active or inactive member with a check mark.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 6: In the next section, designate your primary beneficiary. On the first blank line here, enter their name.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 7: On the second blank line, enter their relationship to you.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 8: On the third blank line, enter their date of birth.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 9: On the fourth blank line, enter their Social Security number.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 10: On the fifth blank line, enter their address.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 11: In the next section, provide the same information for the contingent beneficiary who will receive benefits if your primary beneficiary is deceased.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 12: If you wish to designate additional primary or contingent beneficiaries, enter the same information for them on the back of the form.

 

Alabama Change Of Beneficiary Form Prior To Retirement RSA 100-C Step 13: Sign and date the form before a notary public.

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Form RSA ADDCHGF Address Change Notification

Form RSA ADDCHGF Address Change Notification

 

INSTRUCTIONS: ALABAMA ADDRESS CHANGE NOTIFICATION (Form RSA ADDCHGF)

 

 

To change your registered home address with all Retirement Systems of Alabama accounts, use the form discussed in this article. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

 

Alabama Address Change Notification RSA ADDCHGF Step 1: Part I concerns member information. Check the first box if enrolled in the Employees' Retirement system.

 

Alabama Address Change Notification RSA ADDCHGF Step 2: Check the second box if enrolled in the Teachers' Retirement System.

 

Alabama Address Change Notification RSA ADDCHGF Step 3: Check the third box if enrolled in the Judicial Retirement Fund.

 

Alabama Address Change Notification RSA ADDCHGF Step 4: Check the fourth box if a non-RSA member with an RSA-1 account.

 

Alabama Address Change Notification RSA ADDCHGF Step 5: On the first blank line, enter your first, middle, last and (if applicable) maiden name.

 

Alabama Address Change Notification RSA ADDCHGF Step 6: On the second blank line, enter your date of birth.

 

Alabama Address Change Notification RSA ADDCHGF Step 7: On the third blank line, enter your email address.

 

Alabama Address Change Notification RSA ADDCHGF Step 8: On the fourth blank line, enter your Social Security number. Alternately, enter your account (PID) number on the fifth blank line.

 

Alabama Address Change Notification RSA ADDCHGF Step 9: Part II concerns address information. Enter the effective date of your new address on the first blank line.

 

Alabama Address Change Notification RSA ADDCHGF Step 10: Enter your old street address or P.O. box number, city, state and zip code on the second blank line.

 

Alabama Address Change Notification RSA ADDCHGF Step 11: Enter your new street address or P.O. box number, city, state and zip code on the third blank line.

 

Alabama Address Change Notification RSA ADDCHGF Step 12: Enter your signature on the fourth blank line.

 

Alabama Address Change Notification RSA ADDCHGF Step 13: Enter the date on the fifth blank line.

 

Alabama Address Change Notification RSA ADDCHGF Step 14: Mail this form to the address given at the top of the page. You may also choose to complete and submit this form through Online Member Services at the URL given at the top of the page. For expedited service, fax the form to the number given at the top of the page.

 

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Form RSA DDR Direct Deposit Authorization

Form RSA DDR Direct Deposit Authorization

 

INSTRUCTIONS: ALABAMA DIRECT DEPOSIT AUTHORIZATION (Form RSA DDR)

 

 

Alabama enrollees in the state Retirement Systems can use the form discussed in this article to authorize the direct deposit of benefits in their bank account. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

 

Alabama Direct Deposit Authorization RSA DDR Step 1: Enter your Social Security number on the first blank line.

 

Alabama Direct Deposit Authorization RSA DDR Step 2: Indicate whether the benefit recipient is a retiree or a beneficiary of a deceased retiree or member with a check mark.

 

Alabama Direct Deposit Authorization RSA DDR Step 3: On the second blank line, enter your name.

 

Alabama Direct Deposit Authorization RSA DDR Step 4: On the next three blank lines, enter your full address.

 

Alabama Direct Deposit Authorization RSA DDR Step 5: On the next blank line, enter your daytime phone number.

 

Alabama Direct Deposit Authorization RSA DDR Step 6: On the next blank line, enter your email address.

 

Alabama Direct Deposit Authorization RSA DDR Step 7: Check the first box if drawing benefits from the Teachers' Retirement System.

 

Alabama Direct Deposit Authorization RSA DDR Step 8: Check the second box if drawing benefits from the Employees' Retirement System.

 

Alabama Direct Deposit Authorization RSA DDR Step 9: Check the third box if drawing benefits from the PEIRAF system.

 

Alabama Direct Deposit Authorization RSA DDR Step 10: Check the fourth box if drawing benefits from the Judicial Retirement Fund.

 

Alabama Direct Deposit Authorization RSA DDR Step 11: Check the fifth box if drawing benefits from an RSA-1 account. This can only be authorized for an annual or monthly distribution.

 

Alabama Direct Deposit Authorization RSA DDR Step 12: The next section is for joint financial institution account holders only.

 

Alabama Direct Deposit Authorization RSA DDR Step 13: The benefit recipient should enter their signature on the first blank line at the bottom of the page.

 

Alabama Direct Deposit Authorization RSA DDR Step 14: Enter the date on the second blank line.

 

Alabama Direct Deposit Authorization RSA DDR Step 15: The second page concerns your financial institution and should be completed by a recipient of this institution. They should enter the benefit recipient's name, Social Security number, depositor account number, bank routing number, financial institution name and mailing address, and indicate the type of account with a check mark.

 

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Form TRS SMS 90-528 Statement of Military Service

Form TRS SMS 90-528 Statement of Military Service

 

INSTRUCTIONS: ALABAMA STATEMENT OF MILITARY SERVICE (Form TRS SMS 90-528)

 

 

Active and contributing members of the Retirement Systems of Alabama with a minimum of 10 years service credit under this system may use the form discussed in this article to purchase up to four years of active duty military service credit based upon an honorable discharge. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 1: Enter your name on the first blank line.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 2: Enter your Social Security number on the second blank line.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 3: Enter your street address or P.O. box number on the third blank line.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 4: Enter your city, state and zip code on the fourth blank line.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 5: Check the first statement if you are receiving no benefits for your military service.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 6: Check the second statement if you are receiving a service retirement benefit from a branch of the Armed Forces.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 7: Check the third statement if you are receiving a service retirement benefit based partially on military service from a branch of the Armed Forces. Specify the branch.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 8: Check the fourth statement if you are receiving disability retirement benefits from a branch of the Armed Forces.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 9: Check the fifth statement if you are receiving disability retirement benefits based partially on military service from a branch of the Armed Services. Specify the branch.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 10: Check the sixth box if you received an honorable discharge.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 11: Check the seventh box if you did not receive an honorable discharge.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 12: Enter your signature on the next blank line.

 

Alabama Statement Of Military Service TRS SMS 90-528 Step 13: Enter the date on the last blank line. Have the form certified by a notary public.

 

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Form RSA-1 EMERG Financial Hardship Distribution Request

Form RSA-1 EMERG Financial Hardship Distribution Request

 

INSTRUCTIONS: ALABAMA FINANCIAL HARDSHIP DISTRIBUTION REQUEST RSA-1 DEFERRED COMPENSATION PLAN (Form RSA-1 EMERG)

 

 

When Alabama public employees enrolled in the state-administered RSAI-1 deferred compensation plan experience an unexpected financial hardship, they may used the form discussed in this article to request an emergency distribution from their funds. Such withdrawals are permitted only to the extent reasonably needed to resolve the emergency situation. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 1: On the first blank line, enter your first name, middle or maiden name and last name.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 2: On the second blank line, enter your street address or P.O. box number.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 3: On the third blank line, enter your city, state and zip code.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 4: On the fourth blank line, enter your Social Security number.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 5: On the fifth blank line, enter your phone number.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 6: On the sixth blank line, enter your date of birth.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 7: On the seventh blank line, enter your employer's name and address.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 8: Skip to the second page. Here, a space is provided for you to explain the full nature of your emergency. If necessary, you may attach additional sheets. Documentation must be attached to substantiate your request. Qualifying financial hardships include sudden and unexpected illness or accident, loss of property due to flood, fire or windstorm, or other similar extraordinary and unforeseeable circumstances arising from events beyond your control.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 9: Return to the first page. Enter your signature and the date where indicated.

 

Alabama Financial Hardship Distribution Request RSA-1 Deferred Compensation Plan RSA-1 EMERG Step 10: Appear before a notary public, who will affix their seal to certify this form.

 

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TRS SMS 90-528, Military Service Purchase Act

TRS SMS 90-528, Military Service Purchase Act

 

INSTRUCTIONS: ALABAMA STATEMENT OF MILITARY SERVICE ACT 90-528 (Form TRS SMS 90-528)
 
Any active contributing member of the Retirement Systems of Alabama who has a service credit of 10 years or more may purchase up to four years of active duty military service provided they received an honorable discharge. You are not eligible to do so if in receipt of a service connected military retirement credit. You may apply to purchase this service using a form TRS SMS 90-528, found on the website maintained by the Retirement Systems of Alabama.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 1: On the first blank line, enter your name.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 2: On the second blank line, enter your Social Security number.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 3: On the third blank line, enter your street address or PO box number.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 4: On the fourth blank line, enter your city, state and zip code.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 5: Check the first box if receiving no benefit in connection with military service.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 6: Check the second box if receiving a service retirement benefit from a branch of the armed forces.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 7: Check the third box if receiving a service retirement benefit based partially on military service from a non-armed forces source. Enter the name of this source in the blank provided.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 8: Check the fourth box if receiving a disability retirement benefit from an armed forces branch.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 9: Check the fifth box if receiving a disability retirement benefit from a non-armed forces source. Enter the name of this source in the blank provided.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 10: Indicate with a checkmark whether your discharge was honorable or other.
 
Alabama Statement Of Military Service Act 90-528 TRS SMS 90-528 Step 11: Sign and date the form before a notary public.
 

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Form E1: Membership

Form E1: Membership

 

INSTRUCTIONS: ARIZONA ELECTED OFFICIALS' RETIREMENT PLAN (Form E1)

 

 

Arizona elected officials can enroll in a state administered retirement plan using a form E1. This document can be obtained from the website maintained by the Public Safety Personnel Retirement System of the State of Arizona. 

 

Arizona Elected Officials' Retirement Plan E1 Step 1: On the first line, enter your name. Indicate your gender by circling "M" or "F." 

 

Arizona Elected Officials' Retirement Plan E1 Step 2: On the second line, enter your marital status. 

 

Arizona Elected Officials' Retirement Plan E1 Step 3: On the third line, enter your Social Security number. 

 

Arizona Elected Officials' Retirement Plan E1 Step 4: On the fourth line, enter your birth date.

 

Arizona Elected Officials' Retirement Plan E1 Step 5: On the fifth line, enter your complete home address.

 

Arizona Elected Officials' Retirement Plan E1 Step 6: On the sixth line, enter your home telephone number.

 

Arizona Elected Officials' Retirement Plan E1 Step 7: On the seventh line, enter your email address.

 

Arizona Elected Officials' Retirement Plan E1 Step 8: The next section concerns your employment. If you are an employee of the state of Arizona, check the first box.

 

Arizona Elected Officials' Retirement Plan E1 Step 9: Check the second box if you are a county employee and circle the name of your county.

 

Arizona Elected Officials' Retirement Plan E1 Step 10: Check the third box if you are a town employee and enter its name. 

 

Arizona Elected Officials' Retirement Plan E1 Step 11: Check the third box if you are a city official and enter its name. 

 

Arizona Elected Officials' Retirement Plan E1 Step 12: Enter your position title, your membership date and your current salary on the last three lines of this section.

 

Arizona Elected Officials' Retirement Plan E1 Step 13: In the next section, enter your spouse's name on the first line and their birth date on the second line.

 

Arizona Elected Officials' Retirement Plan E1 Step 14: Enter your spouse's Social Security number on the third line, and the number of children you have under age 18 on the fourth line.

 

Arizona Elected Officials' Retirement Plan E1 Step 15: Enter children's birth dates on the fifth line.

 

Arizona Elected Officials' Retirement Plan E1 Step 16: Document previous elected official employment as directed. Sign and date the bottom of the first page. Name any beneficiaries on the second page.

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