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Note: All forms are in PDF format. You will need to download Adobe Acrobat Reader to view these forms.

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Commonly Downloaded Forms for Retired Members:
Form 115: Notice of Change of Address
Form 110: Authorization for Direct Deposit
Tax: Federal and State Tax Withholding Form
 

 
Forms for Members:
Form 100: Application for Participation
Form 101: Notice of Salary Increases for Active Officers
Form 103: Application for Disability Pension
Form 103A: Municipality Application for Disability Pension in Line of Duty
Form 104: Application for Survivor's Pension for Death In Line of Duty and Death Benefit
Form 105: Application for Survivor's Pension for Death Not In Line of Duty and Death Benefit
Form 106: Application for Service Pension
Form 107: Application for Survivor's Continuation of Pension and Death Benefit
Form 108: Application for Vested Benefit
Form 109: Application for Refund of Contributions
Form 109A: Application for Refund of Contributions and Death Benefit (Beneficiary or Estate Admn.)
Form 110: Authorization for Direct Deposit
Form 111: Deferred Option Plan Application
Form 112: Deferred Option Plan Notice of Termination
Form 112A: Deferred Option Plan Notice of Termination and Death Benefit (Beneficiary or Estate Admn.)
Form 113: Application for Monies Due the Estate
Form 114: Physical/Medical Examination
Form 115: Notice of Change of Address
Form 117: Authorization for Release of Medical/Psychiatric Information
Form 118: Verification of Employment Status
Form 119: Affidavit of Heirship
Form 120: Application for Participation Under the Back Drop Provision
Form 125: Notice of Leave of Absence for Military Service
Form 126: Notice of Return from Leave of Absence for Military Service
Form 127: Service Credit Purchase Application (for Military Service Under USERRA)
Form 130: Historical Payroll Record for Military Service Leave
Form 134: Deferred Option Payout Provision Election
Form 135: Health Election/Change form Form for Eligible Retired Public Safety Officer
Form 136: Deferred Option Payout Provision Notice of Termination
Tax: Federal and State Tax Withholding Form

 

 

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