Laserfiche WebLink
ATTACHMENT "F" <br />RETIREMENTSTATUS FORM <br />** All Contractors who are individuals must complete and sign ** <br />SECTION 1: CONTRACTOR COMPLETES THIS SECTION: <br />Did you retire from one of the State of Washington 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 forthese services? <br />1. Has Contractor been a member of a Washington State Retirement System? <br />lf yes, which system and plan? <br />2. ls Contractor a retiree of a Washington State Retirement System? <br />3. Did Contractor retire before age 55 using the 2008 ERF? <br />I have verified the information above using MRV or by contacting DRS. <br />COU NTY REPRESENTATIVE (Please Print): <br />Signature: Date <br />COUNTY RETAINS THIS FORM <br />Yes <br />Yes <br />Yes <br />Yes <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 No.- <br />Date: <br />SECTION 1: COUNTY COMPLETES THIS SECTION: <br />[Use Member Reporting Verification (MRV) to verify the past retirement membership and document below] <br />-Teachers' <br />Retirement System (TRS) <br />-Plan <br />L <br />- <br />Plan 2 <br />- <br />Plan 3 <br />- <br />School Employees' Retirement System (SERS) <br />- <br />Plan 2 <br />- <br />Plan 3 <br />- <br />Public Employees' Retirement Systems (PERS) <br />-Plan <br />L <br />- <br />Plan 2 <br />- <br />Plan 3 <br />- <br />Public Safety Employees' Retirement System (PSERS) <br />-Plan2 <br />_ Law Enforcement Officers' & Fire Fighters' Retirement System (LEOFF) <br />-Plan <br />L- Plan2 <br />- <br />Washington State Patrol Retirement System (WSPRS) <br />-Plan <br />L <br />- <br />Plan 2 <br />_Judicial Retirement System (JRS) <br />Yes <br />-No <br />Yes No <br />NoYes