Form 29211r3-Public Employees' Retirement Fund Request For Estimate Of Benefits 1997

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Public Employees' Retirement Fund

Request for Estimate of Benefits

We cannot estimate your retirement benefits unless you are within one year of beginning those benefits. An estimation of

your monthly benefit can only be done once a year. Members who want estimates otherwise should request from the

Public Employees' Retirement Fund a copy of the booklet "Estimating Your Retirement Benefits".

Member Information and Address

Name:

First

Middle

(Maiden)

Last

Address:

Street

City

State

ZIP Code

Telephone: (

)

Date of Birth:

(Month/Day/Year)

Social Security Number:

Anticipated date for beginning benefits

(Month/Day/Year): ____________________________________

Anticipated last day at work

(Month/Day/Year):___________________________________________________

The law states that a member who is eligible for normal or early retirement is entitled to choose a retirement date on which their benefit begins if the following

conditions are met:

1. The application for retirement benefits and the choice of date is filed on a form provided by the Public Employees' Retirement Fund Board

of Trustees.

2. The date must be after the cessation of their service and be the first day of the month.

3. The retirement is not more than six months before the date on which the application is received by the Board.

Beneficiary Information

Name:

First

Middle

Last

Date of Birth (Month/Day/Year):

Social Security Number: