Retirement Application Packet Part I Non-State

INSTRUCTIONS: ALABAMA RETIREMENT APPLICATION PACKET FOR NON-STATE EMPLOYEES PART I

Alabama residents who are not employees of the state must prepare for retirement by completing state Form 10. This Application for Retirement is combined with an optional Direct Deposit Authorization Form in a packet available on the website of the Retirement Systems of Alabama.

Alabama Retirement Application Packet For Non-State Employees Part I Step 1: The first page of this packet contains a checklist of steps to take in completing this packet.

Alabama Retirement Application Packet For Non-State Employees Part I Step 2: The second page contain Form 10. Enter your name, Social Security number, home address, date of birth, work and home telephone numbers, and the name of your employer.

Alabama Retirement Application Packet For Non-State Employees Part I Step 3: Indicate with a check mark whether you are retiring due to disability or on a service basis. If the former, you must submit a separate Report of Disability.

Alabama Retirement Application Packet For Non-State Employees Part I Step 4: Give your date of retirement. This must fall on the first of the month in question.

Alabama Retirement Application Packet For Non-State Employees Part I Step 5: Enter your email address.

Alabama Retirement Application Packet For Non-State Employees Part I Step 6: Those who wish for retirement benefits to be administered through direct deposit should enter the name of their bank or financial institution.

Alabama Retirement Application Packet For Non-State Employees Part I Step 7: In the next section, give the name of your primary beneficiary in the event of your death.

Alabama Retirement Application Packet For Non-State Employees Part I Step 8: Provide the relationship of your beneficiary to you, and their date and Social Security number. Answer the next questions with check marks.

Alabama Retirement Application Packet For Non-State Employees Part I Step 9: Sign and date the form. You must then appear before a notary to have the form witnessed.

Alabama Retirement Application Packet For Non-State Employees Part I Step 10: Your employer should complete the last section of this form.

Alabama Retirement Application Packet For Non-State Employees Part I Step 11: If you wish to receive retirement benefits through a direct deposit, provide all information requested on the next to last page. The last page should be completed by a representative of your financial institution.

Form 13: Retired – Direct Deposit Authorization for Retired Members

Form 13: Retired - Direct Deposit Authorization for Retired Members

INSTRUCTIONS: ARIZONA DIRECT DEPOSIT AUTHORIZATION FOR RETIRED MEMBERS (Form 13)

To authorize or cancel direct deposits to the bank account of retired members enrolled in Arizona's state-administered retirement plans for public safety personnel, corrections officers or elected officials, a form 13 should be filed. This document can be obtained from the website of the Public Safety Personnel Retirement System.

Arizona Direct Deposit Authorization For Retired Members 13 Step 1: In the first blank box, enter your Social Security number.

Arizona Direct Deposit Authorization For Retired Members 13 Step 2: In the second blank box, indicate with a check mark whether this authorization should be applied to a retired or DROP account, to a survivor or guardian account, or that of an ex-spouse. If the latter, provide their name.

Arizona Direct Deposit Authorization For Retired Members 13 Step 3: Enter your SYSID, if known, in the third blank box.

Arizona Direct Deposit Authorization For Retired Members 13 Step 4: Enter your date of birth in the fourth blank box.

Arizona Direct Deposit Authorization For Retired Members 13 Step 5: Enter your email address in the fifth blank box.

Arizona Direct Deposit Authorization For Retired Members 13 Step 6: Enter your last name in the sixth blank box.

Arizona Direct Deposit Authorization For Retired Members 13 Step 7: Enter your first name and middle initial in the seventh blank box.

Arizona Direct Deposit Authorization For Retired Members 13 Step 8: Enter your street address in the eighth blank box.

Arizona Direct Deposit Authorization For Retired Members 13 Step 9: Enter your city, state and zip code in the ninth blank box. In the last three boxes of the first part, enter your home number, cell phone number and work phone number.

Arizona Direct Deposit Authorization For Retired Members 13 Step 10: In Section 2, indicate whether this is a checking or savings account with a check mark.

Arizona Direct Deposit Authorization For Retired Members 13 Step 11: Enter your routing number, account number and the name of the financial institution on the next three blank lines.

Arizona Direct Deposit Authorization For Retired Members 13 Step 12: Check the box in Section 3 if canceling a direct deposit authorization.

Arizona Direct Deposit Authorization For Retired Members 13 Step 13: Sign and date the bottom of the page.

Certification of Teacher Aide Service, Teacher Corps Service, and Job Corps Service – Acts 93-768 / 98-385

Certification of Teacher Aide Service, Teacher Corps Service, and Job Corps Service - Acts 93-768 / 98-385

INSTRUCTIONS: ALABAMA CERTIFICATION OF TEACHER AID SERVICE, TEACHER CORPS SERVICE AND JOB CORPS SERVICE ACTS 93-768/98-385

Active, contributing members of the Alabama Teachers' Retirement System who have been enrolled for at least 10 years can purchase up to 10 years of service as a teacher aid or regarding the teacher corps or job corps at any time up to their retirement. The document used to do so can be found on the website maintained by the Retirement Systems of Alabama.

Alabama Certification Of Teacher Aid Service, Teacher Corps Service And Job Corps Service Acts 93-768/98-385 Step 1: On the first blank line of Part I, enter your name.

Alabama Certification Of Teacher Aid Service, Teacher Corps Service And Job Corps Service Acts 93-768/98-385 Step 2: On the second blank line of Part I, enter your complete mailing address.

Alabama Certification Of Teacher Aid Service, Teacher Corps Service And Job Corps Service Acts 93-768/98-385 Step 3: On the third blank line of Part I, enter your city, state and zip code.

Alabama Certification Of Teacher Aid Service, Teacher Corps Service And Job Corps Service Acts 93-768/98-385 Step 4: On the fourth blank line of Part I, enter the name of the TRS system of which you were an employee.

Alabama Certification Of Teacher Aid Service, Teacher Corps Service And Job Corps Service Acts 93-768/98-385 Step 5: Part II of this form is to be completed by your TRS employer. On the first blank line, they will enter your job classification.

Alabama Certification Of Teacher Aid Service, Teacher Corps Service And Job Corps Service Acts 93-768/98-385 Step 6: On the second blank line, they will give the entry date of your TRS membership.

Alabama Certification Of Teacher Aid Service, Teacher Corps Service And Job Corps Service Acts 93-768/98-385 Step 7: The employer should complete the chart below by entering every school year of your employment in the first column, your contract salary in the second column, your actual salary paid in the third column, the number of months worked in the fourth column, the number of months contracted in the fifth column, and the time basis in the sixth column.

Alabama Certification Of Teacher Aid Service, Teacher Corps Service And Job Corps Service Acts 93-768/98-385 Step 8: An authorized official should sign and date Part II.

Application and Certification for Out-of-State Service

INSTRUCTIONS: ALABAMA APPLICATION AND CERTIFICATION FOR OUT-OF-STATE SERVICE CREDIT

Members of the Retirement Systems of Alabama or of the Teachers' Retirement System with 10 years' contributing membership service or more may purchase up to 10 years of out-of-state service in the same capacities by filing the form discussed in this article. It can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Application And Certification For Out-Of-State Service Credit Step 1: Part I should be completed by you. Enter your full name on the first line.

Alabama Application And Certification For Out-Of-State Service Credit Step 2: On the second line, enter your date of birth.

Alabama Application And Certification For Out-Of-State Service Credit Step 3: On the third line, enter your Social Security number.

Alabama Application And Certification For Out-Of-State Service Credit Step 4: On the fourth line, enter your home phone number.

Alabama Application And Certification For Out-Of-State Service Credit Step 5: On the fifth line, enter your street address or P.O. box.

Alabama Application And Certification For Out-Of-State Service Credit Step 6: On the sixth line, enter your work phone number.

Alabama Application And Certification For Out-Of-State Service Credit Step 7: On the seventh line, enter your city, state and zip code.

Alabama Application And Certification For Out-Of-State Service Credit Step 8: If you know your RSA account number, enter it on the eighth line.

Alabama Application And Certification For Out-Of-State Service Credit Step 9: On the ninth line, enter the name of the out-of-state employer. A separate form must be submitted for each one.

Alabama Application And Certification For Out-Of-State Service Credit Step 10: On the tenth line, enter the total duration of service.

Alabama Application And Certification For Out-Of-State Service Credit Step 11: On the eleventh line, note whether or not you were covered by a public retirement system or plan.

Alabama Application And Certification For Out-Of-State Service Credit Step 12: On the twelfth line, note if you are entitled to receive any benefit based on this service other than Social Security. If yes, note what kind on the thirteenth line. Sign Part I.

Alabama Application And Certification For Out-Of-State Service Credit Step 13: Part II should be completed by an official of your out-of-state employer, while Part III should be completed by a representative of your out-of-state retirement plan.

Form IB04 Retiree Enrollment Form

INSTRUCTIONS: ALABAMA RETIREE HEALTH INSURANCE ENROLLMENT FORM (Form IB04)

Alabama state employees who retire can enroll for health insurance through the state using a form IB04. This document can be obtained from the website maintained by the Alabama State Employees' Health Insurance Program.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 1: Indicate with a check mark whether you are seeking basic SEHIP coverage, dental coverage only from Blue Cross, supplemental Blue Cross coverage, or optional Southland policies concerning vision, dental, cancer and hospital indemnity.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 2: On the first line of the first table, enter your full name and sex.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 3: On the second line, enter your Social Security number and date of birth.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 4: On the third line, enter your street address.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 5: On the fourth line, enter your city, county, state and zip code.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 6: On the fifth line, enter your home and work telephone numbers.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 7: If you are seeking dependent coverage, enter the date on which you request it to take effect.

'Alabama Retiree Health Insurance Enrollment Form IB04 Step 8: The next table requires you to list all dependents. The first line is for your husband or wife if applicable. Give their name in the first column, indicate whether they are your husband or wife with a check mark in the second column, give their date of birth in the third column, and enter their Social Security number in the fourth column.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 9: The remaining lines of this table require the same information for any dependent children.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 10: If you have additional group health insurance coverage, document it below. Indicate with a check mark whether this coverage is Medicare A, Medicare B or another insurance. If the latter, specify the coverage.

Alabama Retiree Health Insurance Enrollment Form IB04 Step 11: List the name of any health insurance and/or dental insurance company, the contract holder, the insurance policy and group numbers, and the providing employer's name. Sign and date the bottom of the page.

Retirement Application Packet for State Employees Part I

INSTRUCTIONS: ALABAMA RETIREMENT APPLICATION PACKET FOR STATE EMPLOYEES PART I

Alabama public employees who live in the state can use the packet discussed in this article to initiate the retirement process. This packet can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Retirement Application Packet For State Employees Part I Step 1: The first page is a cover page detailing the contents of the packet.

Alabama Retirement Application Packet For State Employees Part I Step 2: The second page contains a checklist for completion of the retirement process.

Alabama Retirement Application Packet For State Employees Part I Step 3: The third page contains ERS form 10, the actual application for retirement. The first section concerns the member. Provide all information requested.

Alabama Retirement Application Packet For State Employees Part I Step 4: Enter the name of the bank or financial institution to which retirement benefits should be deposited.

Alabama Retirement Application Packet For State Employees Part I Step 5: Enter the name, relationship to you, Social Security number and date of birth of your designated beneficiary.

Alabama Retirement Application Packet For State Employees Part I Step 6: If the designated beneficiary named here is different from the one listed on your account, indicate with a check mark whether you would like the change to take effect upon the submission of this signed and notarized document or on the date of your retirement.

Alabama Retirement Application Packet For State Employees Part I Step 7: Sign and date the form where indicated, then obtain the certification of a notary public.

Alabama Retirement Application Packet For State Employees Part I Step 8: Have your employer complete the bottom of the page.

Alabama Retirement Application Packet For State Employees Part I Step 9: The fourth page contains ERS form 12, an insurance authorization form. Provide all information requested about your wishes regarding health insurance.

Alabama Retirement Application Packet For State Employees Part I Step 10: Obtain the certification of a notary public, then have your employer complete the bottom of this form.

Alabama Retirement Application Packet For State Employees Part I Step 11: The fifth and sixth pages contain form RSA DDR, used to authorize the direct deposit of benefit funds into your bank account. Provide all information requested. Your financial institution should complete the fifth page.

Form TRS TRFTR-1 Transfer of Membership from Teachers’ Retirement System

Form TRS TRFTR-1 Transfer of Membership from Teachers' Retirement System

INSTRUCTIONS: ALABAMA TRANSFER OF MEMBERSHIP FROM TEACHERS' RETIREMENT SYSTEM (Form TRS TRF TR-1)

To transfer your membership from the Alabama Teachers' Retirement System, a form TRS TRF TR-1 should be filed. This document can be obtained from the website maintained by the Retirement Systems of Alabama.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 1: Part I should be completed by you. Enter your first name, given middle name, last name and (if applicable) maiden name on the first blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 2: Enter the name under which you were last employed, if different from the above, on the second blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 3: Enter your Social Security number on the third blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 4: Enter your home street address or P.O. box number on the fourth blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 5: Enter your city, state and zip code on the fifth blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 6: Enter your last employing school system on the sixth blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 7: Enter the date of your last employment in education on the seventh blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 8: Enter the name of your present employer under the Employees' Retirement System on the eighth blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 9: Enter the date on which your present employment began on the ninth blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 10: Enter your signature on the tenth blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 11: Enter the date on the eleventh blank line.

Alabama Transfer Of Membership From Teachers' Retirement System TRS TRF TR-1 Step 12: Part II should be completed by your last TRS employer. They should enter your total current year contributions on the first blank line, contributions to be credited after June 30 on the second blank line, and their signature on the third blank line.

Form RSA-1 ADC Authorization to Defer Compensation RSA-1 Deferred Compensation Plan

Direct Deposit Authorization

INSTRUCTIONS: ALABAMA DIRECT DEPOSIT AUTHORIZATION

Alabama state employees who retire can use the form discussed in this article to authorize payment of retirement benefits through direct deposit. This form is found on the website of the Retirement Systems of Alabama.

Alabama Direct Deposit Authorization Step 1: The first section requires information about the benefits recipient. Indicate with a check mark whether this is the retiree or the beneficiary of a deceased retiree or member.

Alabama Direct Deposit Authorization Step 2: On the first blank line, enter the beneficiary's Social Security number.

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

Alabama Direct Deposit Authorization Step 4: On the third, fourth and fifth blank lines, enter the beneficiary's complete address.

Alabama Direct Deposit Authorization Step 5: On the sixth blank line, enter the beneficiary's daytime phone number.

Alabama Direct Deposit Authorization Step 6: On the seventh blank line, enter the beneficiary's email address.

Alabama Direct Deposit Authorization Step 7: Indicate with a check mark which system or systems you would like your benefits direct deposited from.

Alabama Direct Deposit Authorization Step 8: The next section is to be completed if a joint financial institution account is concerned. If so, the names and signatures of all joint financial institution account holders should be provided, as well as the date.

Alabama Direct Deposit Authorization Step 9: The benefit recipient should sign and date the bottom of the first page.

Alabama Direct Deposit Authorization Step 10: The reverse side of the page should be completed by a representative of the financial institution. In the first blank line of the first section on this page, the name of the beneficiary should be entered.

Alabama Direct Deposit Authorization Step 11: The financial institution representative should enter the beneficiary's Social Security number in the second blank line, the depositor's account number in the third blank line, the routing number on the fourth line, and the name of the financial institution on the fifth line. Indicate whether this is a checking or savings account with a check mark.

Alabama Direct Deposit Authorization Step 12: The financial institution representative should enter their business mailing address and the name or names of all persons on this account. The representative should print and sign their name at the bottom of this page, as well as providing the date and their telephone number.

Form W-4P: Withholding Certificate For Pension Or Annuity Payments

INSTRUCTIONS: WITHHOLDING CERTIFICATE FOR PENSION OR ANNUITY PAYMENTS (Form W-4P)

All or a portion of your Arizona pension benefit may be considered federally taxable. You may complete a federal form W-4P to give the Arizona State Retirement System instructions on how to withhold federal taxes from your pension or annuity payments. This document can be obtained from the website maintained by the Internal Revenue Service.

Withholding Certificate For Pension Or Annuity Payments W-4P Step 1: The top section of the form is a personal allowances worksheet to be completed for your records. Enter "1" for yourself if you cannot be claimed as a dependent by anyone else on line 1 and meet at least one of the three other listed requirements. If you meet another one, enter another "1" on line 2. You may enter the same figure for your spouse on line C.

Withholding Certificate For Pension Or Annuity Payments W-4P Step 2: Enter the total number of dependents you will be claiming on line D, and enter "1" on line E if you will be filing as head of household.

Withholding Certificate For Pension Or Annuity Payments W-4P Step 3: Line F concerns the child tax credit. Total lines A through F and enter the sum on line G.

Withholding Certificate For Pension Or Annuity Payments W-4P Step 4: Detach the worksheet from the bottom half of the page along the line where indicated.

Withholding Certificate For Pension Or Annuity Payments W-4P Step 5: On the first line of the form, enter your first name and middle initial, last name and Social Security number.

Withholding Certificate For Pension Or Annuity Payments W-4P Step 6: On the next two lines, enter your full home address. On the right, enter your claim or identification number of your pension or annuity contract.

Withholding Certificate For Pension Or Annuity Payments W-4P Step 7: Check line 1 if you do not wish to have federal income tax withheld from your pension or annuity. If so, do not complete the remainder of the form.

Withholding Certificate For Pension Or Annuity Payments W-4P Step 8: Complete the Deductions and Adjustments Worksheet on the second page to complete line 2.

Withholding Certificate For Pension Or Annuity Payments W-4P Step 9: Complete the Multiple Pensions/More-Than-One-Income Worksheet on the second page to complete line 3.

Retirement

Judicial Retirement System

Firefighter Certification