Laserfiche WebLink
ATTACHMENT "F" <br />RETIREMENT STATUS FORM <br />** All Contractors who are individuals must complete and sign ** <br />SECTION 1: CONTRACTOR COMPLETES THIS SECIION: <br />Did you retire from one of the State of Washin$on Retirement Systems? <br />Did you retire before age 55 using the 2008 early retirement factors (ERF)? <br />Will you be receiving direct compensation for these services? <br />Willyou be receiving indirect compensation for these services? <br />No <br />No <br />No <br />No <br />CONTRACTOR (Full name of contractor as in DRS filings-Please Print) <br />Signature: Last Four Digits of Social Security <br />Date <br />SECflON 1: COUNW COMPIETES TlllS SECTION: <br />[Use Member Reporting Verificatlon (MRV] to verify the past retirement memberchip and document belowl <br />1. Has Contractor been a member of a Washington State Retirement Sy*em? - Yes <br />- <br />No <br />lf yes, which system and plan? <br />- <br />Teachers' RetirementSystem (TRS) <br />- <br />Plan 1 <br />- <br />Plan 2 <br />- <br />Plan 3 <br />- <br />School Employees' Retirement System (SERS) - Plan 2 - Plan 3 <br />- <br />Public Employees' Retirement Systems (PERS) <br />- <br />Plan 1 <br />- <br />Plan 2 - <br />Plan 3 <br />- <br />Public Safety Employees' Retirement System (PSERS) <br />- <br />Plan 2 <br />_ Law Enforcement Officers' & Fire FighterJ Retirement System (LEOFF) <br />- <br />Plan 1 - Plan 2 <br />- <br />Washington State Patrol Retirement System (WSPRS) <br />- <br />Plan 1 - <br />Plan 2 <br />_ Judicial Retirement System (JRS) <br />Yes <br />Yes <br />Yes <br />Yes <br />Yes <br />Yes <br />No <br />No <br />2. ls Contractor a retiree of a Washington State Retirement System? <br />3. Did Contractor retire before age 65 using the 2008 ERF? <br />I have verified the information above using MRV or by contacting DRS. <br />COU NW REPRESENTATIVE (Please Print) <br />Signature Date: <br />COUT{TY RETAINS THIS FORM <br />Kittitas County Agreement for Services lrev. 5lL4l25l <br />Page 28 of 28