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<br />Professional Services Agreement <br />Page 18 <br />ATTACHMENT "D" <br /> <br />RETIREMENT STATUS FORM (SIGNATURE REQUIRED) <br />COUNTY RETAINS THIS FORM <br /> <br />ALL CONTRACTORS, SERVICES CONTRACTORS, AND INDEPENDENT <br />CONTRACTORS MUST COMPLETE AND SIGN <br /> <br />SECTION 1: CONTRACTOR COMPLETES THIS SECTION <br /> <br />1. Did you retire from one of the State of Washington Retirement Systems? <br /> YES NO <br />2. Did you retire before age 65 using the 2008 early retirement factors (ERF)? <br /> YES NO <br />3. Will you be receiving direct compensation for these services? <br /> YES NO <br />4. Will you be receiving indirect compensation for these services? <br /> YES NO <br /> <br />CONTRACTOR (Full name of contractor as in DRS filings-Please Print): <br />______________________________________________________________ <br /> <br />Signature: ____________________________ <br />Last Four Digits of Social Security Number: ____________________ <br />Date: ____________________ <br /> <br />