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<br />Professional Services Agreement <br />Page 19 <br /> <br />RETIREMENT STATUS FORM (SIGNATURE REQUIRED) <br />COUNTY RETAINS THIS FORM <br /> <br />SECTION 2: COUNTY COMPLETES THIS SECTION (Use Member Reporting <br />Verification (MRV) to verify the past retirement membership and document below) <br /> <br />1. Contractor has been a member of a Washington State Retirement System? <br /> YES NO <br />If yes, which system and plan? <br /> Teacher’s Retirement System (TRS): <br /> Plan 1 Plan 2 Plan 3 <br /> <br /> School Employees’ Retirement System (SERS): <br /> Plan 2 Plan 3 <br /> <br /> Public Employees’ Retirement Systems (PERS): <br /> Plan 1 Plan 2 Plan 3 <br /> <br /> Public Safety Employees’ Retirement System (PSERS): <br /> Plan 2 <br /> <br /> Law Enforcement Officers’ & Fire Fighters’ Retirement System (LEOFF): <br />Plan 1 Plan 2 <br /> <br /> Washington State Patrol Retirement System (WSPRS): <br />Plan 1 Plan 2 <br /> Judicial Retirement System (JRS) <br /> <br />2. Is the Contractor a retiree of a Washington State Retirement System? <br /> YES NO <br />3. Did the Contractor retire before age 65 using the 2008 ERF? <br /> YES NO <br />I have verified the information above using MRV or by contacting DRS. <br /> <br />COUNTY REPRESENTATIVE (Please Print): _____________________________ <br /> <br />Signature: ______________________________ Date: _____________________ <br />COUNTY RETAINS THIS FORM