Redeposit Or Purchase Of Permissive Service Credit

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Redeposit or Purchase of
Permissive Service Credit
California State Teachers’ Retirement System
P.O.Box 15275, MS 88
MS 0287 rev 01/17
Sacramento, CA 95851-0275
800-228-5453
Read these instructions before completing this form. Type or print clearly in black ink.
Use this form if:
• You are a CalSTRS member and wish to redeposit an earlier refund, or if you would like to purchase service credit for service
performed but not credited.
• You previously terminated CalSTRS-covered employment and refunded your CalSTRS contributions and interest. You can
make a full or partial redeposit of your Defined Benefit contributions, plus interest, if you return to CalSTRS membership or
if you are a member of certain California public retirement systems. (See the Purchase Additional Service Credit booklet at
for more information.)
Mail this completed form and any required documentation to the address above to start the process of determining the cost to
purchase service credit. Your request will be verified and you will be billed if you are eligible. You will have 35 days from the billing
statement date to accept the costs and make your first payment.
If you currently are not making contributions to CalSTRS (no earnings have been reported to CalSTRS by an employer for the
current school year), interest will be added to the cost of each permissive service credit bill.
By signing this form, you are under no obligation to purchase service credit.
To purchase other types of service credit, you will need to submit additional forms found at .
• To purchase service credit earned in another state, use the Out-of-State or Foreign School Service Credit Certification form.
• To purchase University of California or California State University service credit, use the Verification for California Public
University Service Credit form.
• To consolidate your Cash Balance Benefit Program service to purchase Defined Benefit Program service credit, use the
Request To Consolidate Benefits form.
For more information, go to . CalSTRS may require additional eligibility information.
Section 1: Member Information
NAME (LAST, FIRST, INITIAL) (INCLUDING ANY PREVIOUS NAMES USED)
CLIENT ID OR SOCIAL SECURITY NUMBER
STREET ADDRESS
DATE OF BIRTH (MM/DD/YYYY)
CITY
STATE
ZIP CODE
(
)
(
)
WORK TELEPHONE
ALTERNATE TELEPHONE NUMBER
EMAIL ADDRESS
CURRENT EMPLOYER (COUNTY AND SCHOOL DISTRICT)
I plan to retire within the next 12 months
_______________
(date, if known)
Section 2: Redeposits
Are you a member of another California public retirement system?
❏ No
❏ Yes
If yes, name of system ___________________________________________________________
Redeposit
I request a billing statement for the cost to redeposit my previously refunded contributions and interest.
I would like to purchase ____________________________ years of service credit. (If you do not specify the number of years,
CalSTRS will process the request for all available years of service.)
Nonmember Spouse/Court Ordered Split
I request a billing statement for the cost to redeposit service credit that was awarded to my former spouse or registered
domestic partner as community property. It is my understanding those funds have been refunded to that person.
Local Service
I request to purchase my local service credit for service performed prior to 1972 in the Los Angeles Unified School District.
REDEPOSIT OR PURCHASE OF PERMISSIVE SERVICE CREDIT • REV 01/17 • PAGE 1 OF 2

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