HomeMy WebLinkAbout18 Contribution Refund Policy TAB 18
CONTRIBUTION
REFUND POLICY
Novemberl6 , 2004
City of Lansing Retirement System
Contribution Refund Policy
Effective November 2004
Along with receiving counseling by the Retirement Office, all employees requesting a refund of
their accumulated contributions are required to complete the attached form, This Corm explains
the impact of the withdrawal on all future claims to a City of Lansing pension,
if the employee chooses to have his/her contribution refunded, the form must be completed prior
to receiving the refund and must be signed by the employee and notarized.
CITY OF LANSING
RETIREMENT SYSTEMS REQUEST FOR REFUND OF ACCUMULATED
CONTRIBUTIONS
DATE SOCIAL SECURITY
I,
ADDRESS
CITY STATE ZIP CODE
DEPARTMENT
Hereby request a refund of all accumulated contributions standing to my credit in the Police and
Fire Retirement System, i do hereby understand that upon withdrawal of all my retirement
contributions, I am forfeiting all rights to any pension through the City of Lansing, to any future
health care coverage, to any future dental care coverage or to any term life insurance policy
benefits through the City of Lansing and that, I am forfeiting all accumulated service credits. I
do hereby understand that upon withdrawal of all my retirement contributions, I am forfeiting the
right to use the RECIPROCAL RETIREMENT ACT (Act 88 of 1961) to draw a pension from
the City of Lansing, in case I am employed with another municipality, which participates in the
Reciprocal Retirement Act.
REASON FOR REFUND
SIGNED
Subscribed and sworn before me this day of_ Notary public in
County, State of Michigan.
My commission expires
Signed