Cash Remittance Form - Strs Ohio
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1CASH REMITTANCE
Please send check(s) and this form to:
STRS Ohio, P . O. Box 631135, Cincinnati, OH 45263-1135
If you use wire transfer or ACH, you can fax this form to 614-227-4683.
If you are submitting contributions for more than one employer, please complete a separate form for each employer.
If you have questions, please call STRS Ohio toll-free at 888-535-4050 or visit
Section 1 — Employer Information
Four-digit
Employer name _______________________________________________
employer number _________________
Section 2 — Payment Method and Amount
❑
❑
❑
Check(s)
Wire transfer*
ACH (Automated Clearing House)*
Total amount $ _____________
Date ______________________
Date ______________________
Total amount $ _____________
Total amount $ _____________
*Complete a separate form for each wire transfer or ACH.
Section 3 — Contribution Amounts Included in Payment
Check number
Amount
Leave blank if wire transfer or ACH
Complete for check(s), wire transfer or ACH
❑
Employee contributions
Pay date(s) _________________________
____________________
$ ____________________
____________________
$ ____________________
____________________
$ ____________________
❑
Employer contributions
Pay date(s) _________________________
____________________
$ ____________________
Section 4 — Other Amounts Included in Payment
Check number
Amount
Leave blank if wire transfer or ACH
Complete for check(s), wire transfer or ACH
❑
ARP contributions (submit monthly)
(College or university ONLY)
____________________
$ ____________________
Fiscal month ___________________________
❑
Payroll deduction for purchase of
service credit
(Submit copy of payroll deduction report)
____________________
$ ____________________
Fiscal month ___________________________
❑
Adjustments to member accounts
____________________
$ ____________________
❑
Payment for invoice
____________________
$ ____________________
(Submit copy of invoice)
❑
Other ______________________________
____________________
$ ____________________
❑
Other ______________________________
____________________
$ ____________________
Total of amounts in Sections 3 and 4 should equal the total payment amount listed in Section 2.
Date submitted ______________________________________________________________
Signature ___________________________________________________________________
50-269, 3/16/0
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