Transcription of HARDSHIP WITHDRAWAL APPLICATION - CalSTRS.com
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HARDSHIP WITHDRAWAL APPLICATION - CalSTRS.com
PERSONAL INFORMATION (please print clearly using black or blue ink) NAME: _____ SOCIAL SECURITY NUMBER: _____ ADDRESS: _____ APT: _____ CITY: _____ STATE: _____ ZIP CODE: _____ DAY PHONE:_____ EVENING PHONE: _____ EMAIL: _____ SCHOOL DISTRICT PLAN NUMBER: _____ _DATE OF BIRTH: _____ /_____ /_____ (Not required) INSTRUCTIONSHARDSHIPWITHDRAWAL APPLICATIONPAGE 1 of 6 PLEASE NOTE: AN INCOMPLETE APPLICATION OR NOT SUPPLYING ALL REQUIRED DOCUMENTATION WILL CAUSE A DELAY IN RECEIVING YOUR Review and complete HARDSHIP Requirements to determine if you are ELIGIBLE to take a HARDSHIP WITHDRAWAL .
HARDSHIP WITHDRAWAL APPLICATION HARDSHIP WITHDRAWAL / PAGE 2 of 6 CHOOSE TAX WITHHOLDING AND GROSS UP ELECTION Tax Withholding Elections:Regardless of whether or not federal or state income tax is withheld, you are liable for taxes on the taxable portion of the payment.
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