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Home My WebLink About1925,1937-1953 FundApplication for Participation in the Deferred Retirement Option Plan (DROP) For 1925~ 1937, and 1953 Fund Members Instrucuons for'Completing this Form Please Read Carefully IMPORT~T: I. Please ~yfle orfldnr. Use black ink. 2. Com~kte all informa~ion. Remember to indude your name and Social Seotri~ Number. 3. Return the completed form direc;) to the fiscM oficer 'Clerk-Treasurer or Controller;. ~t cop5 should be made and forwarded to the pension secreraSv and police orfire chief. You may also make a copy for your records. STEP 1: MEMBER INFORMATION Member's Social Security Number: Enter al2 nine digits of your Social Security Number. Your appl/cation will not be processed without this information. Date of Application: Enter the date you completed the application. Member's Name: Enter your first name, rmddle initial, and last name. Member's Address: Enter your full street ad&ess. City: Enter the dry. State: Enter the scare ZIP Code: Enter your five or me-digit ZIP Co&. Member's Phone Number: Enter your work and home telephone numbers, begnnnmg with area code. Please note which is work or home and if it is a day or evening phone number. E-mail address: Enter your E-mall ad&ess, if you have one. STEP 2: DROP ELECTION DATES DROP Entry_ Date Please enter th~date as MB/I/DD/YYYY. You must have at least 20 years of service. This date cannot be earl/er than January 1, 2003 or later than December 31, 2006. DROP Retirement Date (Effective Date of Retirementl Please enter the date as IVIM/DD YYYY. This date must be at least twelve (12) months after your DROP Entry Date. It cannot be more than tarry-sLx (36) months after your DROP Entry Date. It cannot be earlier than January 1, 2004 or later than December 31, 2007. Important Note You may select any day of the month as a DROP Entry Date or DROP Retirement Date. However, your DROP lump sum amozmi will be calculated based upon the number of completed calendar months. The length of the DROP period must be no less than twelve (I2~ months and no more than thirty-s~x (36) months. Your DROP Retirement Date is the first day your retirement benefit is effective. Your retirement is effective on the first day after your last day o f employment. Please caretS_ally choose this date. Example 1: If you select a DROP Entry Date of March 20, 2003 and a DROP Retirement Date of March 20, 2005, your DROP lump sum wkll be calculated based on 24 completed months. Your DROP Retirement Date is the day after your last day of employment. In order to be eligible to choc se the DROP benefit, your employer must cerufy that your last day of employment is March 19, 2005. Your pension will begm as soon as admimstrauvely possible and you ~vonld be paid a prorated renrement benefit for March 2005, and a full month's pension benefit in April 2005. Example 2: If you select a DROP Entry Date of March 20. 2005 and a DROP Retirement Date of March 1, 2005, kour DROP lump stun will be calculated based on 23 months of time in the DROP because 5~ou ~viI1 only have been in the DROP for 23 full months. In order to be eligible to choosa the DROP binefit, your employer must cerUfy that 7our last day of employment is February 28, 2005. Your pension will begm as soon as administratively possible and you will be paid a full month's pension benefit for March 2005. MEMBER ACKNOWLEDGEMENT Please read the notice that your choice )f DROP Entry Date and DROP Retirement Date cannot be changed after this form is recmved by the s fiscal officer. Then s~gn and print your name acmaowted=mng you have read and understand the notice. RETURN THE FORM TO THE FISCAl. OFFICER t '.ERK- tREAowRER OR CONTROLLER) - fiscal ~fficer. This applicalion must be received ~ the fiscal offcerpffor to the DROP Entr~ Date. MEMBER NOTE: CH2t,NGES TO INFORMATION- IF YOU HAVE ANY CHANGES TO A_NY OF THE INFORMATION ON THIS FORM SUCH AS YOUR NAME OR ADDRESS, PLEASE IMMEDIATELY NOTIFY THE UNIT'S FISCAL OFFICER. THIS IS TO ENSURE THAT YOU RECEIVE CORRECT AND IMPORTANT INFORMATION REGARDING YOUR BENEFITS AND TAXES. HELPFUL INFORMATION- INDIANA ASSOCIATION OF CITIES 2MN'D TOWNS TELEPHONE: (317 237-620( FAX (317) 237-6206 WEBSITE: ww,,v.citiesandtowns, org PERF TELEPHONE NUNIBERS: Indianapolis & vicimry (317] 233-4162, Toll-Free Nmnoer (888) 526-1687 TDD ~earing wnpaired number) (317) 233=4160 F,~X N~tmber (317~ 232-1614 WEBSITE: atomy, state.re.us/peri 1977 FUND TELEPHONE: (31~ 233-4146 FA~X. Number (317) 234-1529 INTERNAL REVENUE SERVICE TELEPHONE NUMI3ERS: Toll-Free Nttmber I-(829) 829-104(. TDD (hearing impaired numbet 1480( -82%4059, Tele Tax i- '800~-829-4477 IRS PUBLICATION 575. PENSION AND ANNUITY INFOR2vf. ATION [RS PUBLICATION 590. INDIVIDUAL 1LETIiLEMENT ,'LRRANGE~IENTS WEBSITE: w~v.irs.gov INDIANA STATE DEPARTMENT OF REVENUE (DOR) TELEPHONE: Indianapolis & vicMity (317~ 233-4018, TDD (hearing mapaired number) '317} 233-4952 Fax Number (3I~ 233~2329 · Individual lncome Tax Questions 317) 232-2240 \VEBSITE: ~vww.in.gov dor Application for Participation in the Deferred Retirement Option Plan (DROP) For 1925, 1937, and 1953 Fund Members INSTRUCTION$:" 1. Please TYPE or PRiPOT. Use black ink. 2. Compkte al/information. Remember to put. your name and Soda/Secufft. y Number at the top of evesy page. 3. Return the compMed form ch3ect~ to the Unit's fiava/ offver. Do Not tetu~'n the instruction pages. Date (MM/DD/YYYY) Fiest Name iNff ' T~ast nafne Address City State Zip Code Day Phone Evening Phone E-mail Address DROP Entry Date ~lust have 20 years of service by this date) (MM/DD/YYY~ DROP Retirement Date (M2v£/DD/YYYY) (Effective Date of Retirement) (Must be 12 - 36 months after DROP Entry Date First Class Annual Salary as of DROP Entry Date $ I elect the above dates for participation in the Deferred Retixement Option Plan (DROP). I understand that in order to remain elig4ble for DROP benefits upon retirement, my choice of dates for entry and reffucement under the DROP cannot be changed after this form is received by the fiscal officer, and by signing below I ackazowledge that I have read and understand this statement. Member Signature Printed Name Return this form to: THE FISCAL OFFICER (Controller or Fiscal Officer)