Form C4 - Application For Normal Retirement - 2011 Page 13
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22CORRECTIONS OFFICER RETIREMENT PLAN
FORM C11
08/11
3010 E. Camelback Rd., Suite 200, Phoenix, Arizona 85016
Page 1 of 1
(602)255-5575 FAX (602)296-2369
BENEFIT CALCULATIONS (A.R.S. Section 38-885)
USE THIS FORM FOR NORMAL SERVICE RETIREMENTS, SURVIVING SPOUSE AND GUARDIAN BENEFITS
Member Name
Employer
Birth Date:
Social Security Number:
Amount of Final Contribution to CORP:
$
for Pay Period Ending
Service Dates From:
Through:
days 365 days =
Years of Service:
years
years
days 365 days =
Prior Service:
years
years
days 365 days =
Less Non-Credited Service:
(
)
years
(
)
years
days 365 days =
Length of Credited Service:
years
years
A. COMPENSATION - BASE SALARY paid to member during a period of 36 consecutive months of credited service in
which member received highest base salary within the last 120 months of service:
YEAR
AMOUNT
YEAR
AMOUNT
$
$
through
through
$
$
through
through
$
$
through
through
$
$
through
through
B. TOTAL AMOUNT of highest 36 consecutive months of base salary: ……………………….
$
C. AVERAGE MONTHLY COMPENSATION - LINE B 36 months: ………………………………
$
D. For retirement with 20 years of credited service but less than 25 years of credited
service (Not available to dispatchers) and (if applicable) 80 point rule if membership
date is on/after 8/9/01:
1. Line C x 50%…………………………………………………..
$
2. PLUS 2% of Line C for each year of credited service
over 20 years
…………………………………………………
$
3. TOTAL MONTHLY BENEFIT: ………………………………………………………………..
$
E. For retirement with 25 or more years of credited service and (if applicable) 80 point rule
if membership date is on/after 8/9/01:
1. Line C x 50%…………………………………………………..
$
2. PLUS 2.5% of Line C for each year of credited service
over 20 years (MAXIMUM - 12 years) …….………….
$
3. TOTAL MONTHLY BENEFIT: ………………………..………………………………………
$
F. For retirement with less than 20 years of credited service and (if applicable) 80 point rule
if membership date is on/after 8/9/01:
Line C x years of credited service (include fractional years) x 2.5% (0.025)……………………...
$
G. For retirement with 80 point rule and membership date is PRIOR to 8/9/01:
Line C x years of credited service (include fractional years) x 2.5% (0.025)
(MAXIMUM 75% Line C)……………….........................................................................................
$
H. For retirement at age 62 with 10 years of service:
Line C x years of credited service (include fractional years) x 2.5% (0.025)………………..........
$
I. Surviving Spouse or Guardian Benefit: 4/5 of Line D3, E3, F, G or H, whichever is
applicable; or if member not retired at date of death, 40% of Line C; except 100% of Line C
if member killed in line of duty………………………………………………………………….……
$
CALCULATED BY:
DATE:
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