Form Rs 2050 (Rev. 3/02) - Adjustment Report
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1
2Adjustment Report
RS 2050
(Rev. 3/02)
Office of the New York State Comptroller
New York State and Local Retirement System
SEE INSTRUCTIONS FOR COMPLETING FORM ON BACK
Employees’ Retirement System
Police and Fire Retirement System
110 State Street, Albany, New York 12244-0001
Employer Name
Employer Code
Report Code
0
Page________of________
Salary
Member’s Name
Report Period
Days
Days for Period
Additional
Retirement Registration
Salary for Period
Contributions For Period
Social Security Number
Last
First
M.I.
Month/Year
Adjustment
Should Be
Adjustment
Number
Should Be
Contribution Adj.*
Should Be
I certify that the adustments on this form constitute a true, correct and complete accounting of all such adjustments.
TOTALS
They have not been and willl not be shown on any other report. I certify that each person actually worked the
adjusted number of days or was paid the adjusted amount of salary, and that this data was determined according
to Part 315 of Title 2 of the New York State Codes, Rules and Regulations.
Use these columns only if check is
Date
enclosed
Certified By
Title
Telephone Number
(
)
All changes to your monthly report (except reductions in contributions) must be done on this form. For adjustments to loans or arrears, please call 518-474-2987 for instructions.
RETIREMENT SYSTEM USE ONLY
Date
Examined By
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