Transcription of FloridaRetirementSystemPensionPlan ... - Miami …
1 FloridaRetirementSystemPensionPlanDeferr edRetirementOptionProgram( drop )Terminati onNotificationPOBOX3090 Tallahassee,FL32315-3090 LocalPhone:850-907-6500 TollFree:844-377-1888 FAX:850-410-2010DP-TERMRev. 04/13 DROPTerm/RefundRule , 1of 1 MemberVerification:TerminationRequiremen t:Inordertosatisfyyouremploymentterminat ionrequirement,youmustterminateallemploy mentrelationshipswithallparticipatingFRS employersforthefirst6 positioncoveredornon-coveredbyretirement forthefirst6 notlimitedto:part-timework,temporarywork ,otherpersonalservices(OPS),substitutete aching.
2 Youmayreturntoworkfora participatingFRSemployerduringthe7th- 12thcalendarmonthsfollowingyourDROP terminationdate, youfailtomeettheterminationrequirement,y ouwillvoid(cancel)yourretirementandDROP participationandyoumustrepayallretiremen tbenefitsreceived(includingaccumulatedDR OP benefits).Ifyouvoidyourretirement,yourem ployerwillberesponsibleformakingretroact iveretirementcontributionsandyouwillbeaw ardedservicecreditfortheperiodduringwhic hyouwerein toacknowledgethatI :(signin thepresenceofa Notary)Notary:Stateof, Countyof.
3 Theabovenamedpersonwhohassworntoandsubsc ribedbeforemethisdayof20andwhois ,TypeorStampCommissionedNameofNotaryPubl icEmployerCertificationofEmploymentTermi nation:Thisis tocertifythattheDROP participationfortheabovenamedmemberwillt erminateorhasterminatedonwiththeAgency,w hoI amauthorizedtorepresent.(Date)Authorized Signature:PositionTitle:PrintName:PhoneN umber:AgencyName:Agency#Date:MemberName: MemberSSN:MailingAddress:HomeTelephoneNu mber:Accordingtoourrecords,yourDROP terminationdateis . YoumustterminateallFloridaRetirementSyst em(FRS) 'sauthorizedrepresentativemustcompleteth isformcertifyingyourDROP employmenttermination.
