Application For Retirement Annuity
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2PARK EMPLOYEES’ ANNUITY AND BENEFIT FUND of CHICAGO
55 East Monroe Street, Suite 2720 - Chicago, Illinois 60603
Tel. # (312) 553-9265 - Fax # (312) 553-9114
APPLICATION for RETIREMENT ANNUITY
The
Retirement
Board
of
the
Park
Date: ____________________
Employees’ Annuity and Benefit Fund in
forwarding this blank form does so solely at
I hereby apply for an annuity from the Park Employees’ Annuity and Benefit
the request of an eligible member.
This
Fund under the provisions of the Act governing said Fund as now in force. I
form must be completed and submitted
have or will be withdrawing from the service of the Chicago Park District. I
prior to the proposed retirement date. If
understand that retirement benefits cannot be received until my service has
not, date of receipt will be the date used as
been terminated.
date of retirement.
Retirement Date
Initials
DOCUMENTS NEEDED
Depending on your marital/civil union status at the time of retirement, please include the following listed documents:
If unmarried
If currently married or party to a civil union
If divorced or widowed
• your birth certificate
• your birth certificate
• your birth certificate
• your spouse’s birth certificate
• divorce decree or spouse’s death
• your marriage certificate
certificate
Please note that for all purposes, the term “spouse” shall refer to marriage spouse and civil union spouse and the term “divorce” shall refer to
dissolution of a marriage and a civil union. Other legal documents may be needed in order to complete our verification process.
EMPLOYEE’S AFFIDAVIT
Please fill out completely and in accordance with your legal documents.
Social Security Number
1.
Full name of applicant (please print)
2.
Present legal address
Street
City
State
Zip code
3.
Telephone Numbers/Email Address
Home:
Mobile
Email
4.
Place and date of birth
(City, County, State or Country)
(Month)
(Day)
(Year)
Yes If Yes: Type of record (include proof)
5.
Is your answer to question 4 derived
from a written or printed family or
public record?
No
If No: From whom or how was it derived?
Name of Child
Date of
Living
If adopted child, give
Birth
with you?
date of adoption
“Yes” or “No”
6.
List all your living unmarried
children under the age of 18 as of
the date of retirement.
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