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State Employees’
Retirement System
of Illinois
RETIREE &
SURVIVOR
BENEFITS
&
Your
Rights Responsibilities
H A N D B O O K
RETIREMENT
Springfield, IL 62794-9255
2101 S. Veterans Parkway
SYSTEMS
STATE
P O. Box 19255
January 1, 2008
.
SERS MISSION STATEMENT
To provide an orderly means whereby aged or disabled
TABLE OF CONTENTS employees may be retired from active service, without
prejudice or hardship, and to enable the employees
to accumulate reserves for themselves and their
1. General Information .........................................1 dependents for old age, disability, death and termination
of employment, thus effecting economy and efficiency
Addresses & Phone Numbers ..................................... 2 in the administration of the State Government.
Annuitant Workshop ................................................. 3
1.GENERAL
Group Insurance ......................................................... 4
2. Retiree Information ...........................................5
INFORMATION
Annuity Payments....................................................... 6
Reemployment ............................................................ 9
3. Survivor, Widow & Occ. Death Benefits .......... 11 This handbook presents you with a general overview of
Annuity Payments......................................................12 SERS benefits for all retired state employees and their
survivors who receive benefits. SERS offers a variety of
Lump Sum Death Benefits.........................................15 benefits to members and survivors. These benefits, when
combined with other income, are designed to provide
members with financial security in their retirement
4. Appendix ......................................................... 17
years.
Glossary..................................................................... 20 Read this booklet carefully and keep it for reference.
Make sure your loved one is also familiar with this hand-
Sample Annuity Payment Stub ................................. 23 book and that he or she knows where your important
Sample Form W-4P ................................................... 24 papers are located.
This handbook is intended to serve as a supplement
Sample Form 1099-R ................................................. 25 to your annual Benefit Statement, which is mailed to you
Sample Direct Deposit Earnings Statement ............. 26 in March. If you have questions about any of the infor-
mation in this handbook, call us at any of the phone
Map to SERS ...............................................................27 numbers listed on page 2.
1
ADDRESSES & through our post-retirement workshops. Our
website contains our annual financial report,
PHONE NUMBERS a summary of the Illinois State Board of In-
vestment annual financial report, and a link
to other state and federal agencies.
You may contact us SPRINGFIELD ANNUITANT NEWSLETTER
2101 S. Veterans Parkway, P. O. Box 19255 All retirees, survivors, widows,
Monday thru Friday and occupational death annuity
Springfield, IL 62794-9255
from 8 a.m. until General: 217-785-7444 recipients receive at least three
4:30 p.m. E-mail us Fax: 217-785-7019 editions of the newsletter, The
with any questions Deaths: 217-785-7366 Informer, each year. This newsletter keeps you
and/or comments Pensions: 217-785-7343 informed of any issues or legislation affecting
Insurance: 217-785-7150 you. Your annual Benefit
at: ser@mail.state.
il.us. Statement is mailed
CHICAGO ANNUITANT WORKSHOP
to you every March.
Michael A. Bilandic Building SERS offers the workshop, Myths & Realities
of Retirement (MRR), to all State of Illinois The statement in-
160 North LaSalle Street, Suite N725
Chicago, Illinois 60601 retirees and their survivors. This free, one-day cludes information
312-814-5853 workshop covers a variety of important top- on group insurance
Fax: 312-814-5805 ics: SERS entitlements, estate planning, group and your beneficia-
insurance and financial planning. It also
ries. It also contains
TDD/TTY discusses other topics pertaining to retirees.
To enroll in this informative workshop call an identification
A Telecommunications Device for the Deaf
(TDD) is available for members and annui- 217-785-6979. card.
tants who are hearing or speech-impaired.
You may access this service at 217-785-7218. ANNUITANT ADDRESS
A permanent mailing address is maintained
INTERNET for each annuitant of SERS. This is necessary
SERS is on the Internet at www.state.il.us/srs. for the mailing of special notices, newsletters
Our goal is to educate you about the retire- and Group Insurance Program information.
ment and death benefits provided by SERS. It is important to maintain your perma-
The website provides an overview of ben- nent mailing address and report any changes.
efits, and gives you easy access to a variety of Annuitants can report a change of address by
information: current retirement issues, how calling or writing the SERS Springfield or Chi-
to contact us, answers to frequently asked cago offices. A change of address form may be
questions, and education opportunities downloaded from our website at www.state.
il.us/srs.
2 3
GROUP INSURANCE
Retirees, survivors, widows, and occupational
death benefit recipients can participate in the
State Employees’ Group Insurance Program,
To protect your pri- as described in the Department of Central
vacy, all information Management Services (CMS) group insurance
contained in your booklet. You may also cover eligible depen-
SERS record is con- dents and have the premium deducted from
your monthly benefit check.
sidered confidential, Several group health plans are available.
2.RETIREE
and is provided only Benefits may vary among plans, but all bene-
to you and to those fits are coordinated with Medicare when appli-
you permit to have cable. In addition to group health, dental and
access. vision insurance, term life insurance coverage
is also available to eligible members.
For more information, contact SERS’ Insur-
ance Section, refer to your State of Illinois
Member Handbook, or visit our website: www.
INFORMATION
state.il.us/srs.
MEDICARE
Members age 65 or older who qualify for
Social Security benefits are also eligible for
Medicare. Medicare is made up of two parts:
Part A is free hospital insurance; Part B is
optional medical insurance which requires a
member-paid premium. In certain situations,
disabled members under age 65 may also
qualify for Medicare.
Illinois State Employees’ Group Health
Insurance Program benefits coordinate with
Medicare to provide overall comprehensive
coverage between the two plans. Contact the
Social Security Administration if you have
questions about Medicare.
4 5
RETIREMENT ANNUITY DIRECT DEPOSIT
(Electronic Funds Transfer)
(PENSION) When you apply for a SERS benefit, you
will receive a Depository Agreement form
along with an explanation of this program.
We encourage you to have your monthly
All SERS records are FIRST RETIREMENT retirement annuity directly deposited into
maintained by your ANNUITY PAYMENT your bank account. Complete and return
Social Security num- SERS processes your first annuity payment this form with your application for ben-
after we receive your pension application efits. This form can also be downloaded
ber. In order to re-
and other required information. The normal from our website (www.state.il.us/srs).
ceive any benefit, processing time is 36 days from the date you When you choose Direct Deposit, your
you must apply for leave service. first two payments are mailed to your
it. All benefit claims The Comptroller’s office will mail the first home. All future payments will be depos-
should be made to annuity payment directly to your home. You ited into your bank account on the 19th of
will also receive a Notice of Pension Approv- each month. You will not receive a payment
the SERS Claims Divi-
al, which contains information about your stub for each direct deposit payment. Instead,
sion. After you begin retirement annuity; a tax brochure, which the Comptroller’s office will periodically issue SERS is a defined
receiving benefits, provides an overview of your annuity taxes; an earnings statement with information about benefit plan. Both
you should notify and a payment stub with information about your annuity payment. (See page 26 for a you and the State
SERS if you change your payments. (See page 23 for a sample of sample earnings statement.)
make contribu-
this stub.)
your name or address. tions to us during
TAXATION OF YOUR
FUTURE RETIREMENT RETIREMENT ANNUITY your employment to
ANNUITY PAYMENTS Illinois law exempts all SERS benefits from cover the cost of your
Future annuity payments are mailed on the state income tax, but your benefits are subject retirement benefit.
19th of each month, unless the 19th is on a to federal income tax. If your federal tax with-
Your benefits are
weekend or holiday, when they are mailed on holding information is not on file with SERS,
the last working day before the 19th. If your taxes are withheld using the rate for a married based on the laws
payment is mailed directly to your home, al- person with three exemptions. (See the sample in effect on your last
low ten working days for delivery. W-4P form on page 24.) day of employment.
If you have not received your payment Each year, the Comptroller’s office is re-
after the ten working days, call SERS. Fail- quired to send you a 1099-R form showing the
ure to advise SERS of an address change may total annuity amount you received during the
result in a delayed payment. past year, as well as any taxes withheld. (See
the sample 1099-R on page 25.)
6 7
TAXATION OF REFUND
ASSOCIATED WITH RETIREMENT RETIREE REEMPLOYMENT
Widow/survivor contribution refunds and
alternative retirement formula contribution
refunds are also subject to federal income tax
RETURNING TO EMPLOYMENT
withholding, but you can rollover your lump
AFTER RETIRING
sum payment and defer tax on it until a later
If you return to state employment on a con-
date. (Refer to the Tax brochure for more tractual basis (the 2002–2003 ERI participants
If you receive a wid- information.) may not work contractually), or for the
ow/survivor contribu- If you elect to rollover all or part of your private sector, your SERS benefit is not af-
tion refund because widow/survivor refund, or alternative retire- fected. However, if you return to state em-
you were not married ment formula refund, you will receive a ployment on a non-permanent or permanent
at retirement and you 1099-R form by January 31 of the following basis after retirement, you should notify the
later remarry, you year from the Comptroller’s office which will SERS Claims Division immediately.
reflect the amount rolled-over. If you receive a pension from more than
can repay the refund
one Illinois public retirement system which
plus interest after INCREASES FOR RETIREES participates in the Retirement Systems’ Recip-
you have been mar- SERS retirees receive a 3% increase to their rocal Act, you must notify each retirement
ried one full year, to pensions on January 1 following their first system. Each reciprocal retirement system
qualify your spouse full year of retirement, or age 60, whichever has specific rules to determine if retirees are
is later. Future increases of 3% of your cur- eligible to receive pension benefits during
for a survivor benefit.
rent pension will also be made each January reemployment.
1 thereafter. Future increases are not limited
by the 75% maximum. NON-PERMANENT REEMPLOYMENT
If you retired using the Rule of 85, you If your employment with the state will last for
75 or less working days during a calendar year
are eligible for your first increase on January
(any part of a day is counted as a full day),
1 following your first full year of retirement,
you will continue to receive your pension pay-
even if you are not age 60. If you retired un-
ment while employed. During your employ-
der the alternative formula, you will receive
ment, you make no contributions to SERS, but
a 3% increase to your pension on January 1 you must contribute to Social Security.
following your first full year of retirement or If you work more than 75 working days,
age 55, whichever is later. Future increases are your pension benefit will end on the 76th day,
not limited by the 80% maximum. and you will resume contributing to SERS.
8 9
PERMANENT REEMPLOYMENT
If you are reemployed by the state on a
permanent basis, you won’t be eligible for
pension benefits while working. You will
make contributions to both SERS and Social
Security during your employment and earn
additional service credit.
After you again retire from state employ-
ment, you must reapply for a pension.Your
new pension amount will be the benefit
earned before reemployment, plus
SURVIVOR,
3.
the pension amount earned during
your reemployment.
If you reenter state service
WIDOW, &
within three years after retiring,
you may qualify to have your
new retirement benefit computed
OCCUPATIONAL
as though you never retired. To
qualify, you must repay all of the
pension benefits you received, plus
DEATH BENEFITS
interest.
The repayment may be made in a lump
sum, by installments paid within five years
after your reemployment, or before your next
retirement date, whichever is first. If you
choose not to complete installment payments
before retirement or the end of the five-year SERS must always be notified in
period, your installment payments will be re- the event of your death.
funded and your pension will not be recom-
We can’t process any payments
puted.
to your beneficiary until we receive a
certified copy of your death certificate.
10 11
SURVIVOR, WIDOW, SOCIAL SECURITY OFFSET
If an employee contributed to both SERS and
OCCUPATIONAL DEATH Social Security, an offset of 50% of the survi-
vor’s Social Security benefit is usually applied
ANNUITY PAYMENTS to the SERS widow’s
or survivor’s benefit DIRECT DEPOSIT
when the survivor (Electronic Funds Transfer)
reaches age 60. When you apply for a SERS benefit, you will
In order to receive FIRST SURVIVOR, WIDOW, OCCUPA- If the survivor is receive a Depository Agreement form along
any benefit, you TIONAL DEATH ANNUITY PAYMENT over age 60 when the with an explanation of this program. We
SERS will process your first annuity payment benefit begins, the encourage you to have your monthly retire-
must apply for it.
after we receive your application and other offset starts with the ment annuity directly deposited in your bank
All benefit claims first payment. These
required information. The normal processing account. Complete and return this form with
should be made to offsets do not reduce your application for benefits.
time is 30 days.
the Claims Division. The Comptroller’s office will mail the first
the SERS widows or When you choose direct deposit, your
After you begin re- survivors benefit by first two payments are mailed to your home.
annuity payment directly to your home. You
more than 50%.
ceiving benefits, you will also receive a Notice of Benefit Approval, All future payments will be deposited into
should notify SERS which contains information about your annu- your bank account on the 19th of each
MARRIAGE
if you change your ity; a tax brochure, which provides an over- month.
If a child under age
view of your annuity taxes; and a payment You will not receive a payment stub for
name or address. 18, or age 22 if full-
stub with information about your payment. each direct deposit payment. Instead, the
All SERS records time student, marries,
are maintained
(See page 23 for a sample of this stub.) their survivor, widow, Comptroller’s office will periodically issue an
or occupational death earnings statement with information about
according to your FUTURE SURVIVOR, WIDOW, your annuity payment. (See page 26 for a
benefit will be termi-
Social Security OCCUPATIONAL DEATH ANNUITY nated. sample earnings statement.)
number. PAYMENTS
Future annuity payments are mailed on the TAXATION OF THE SURVIVOR, WIDOW,
19th of each month, unless the 19th is on a OCCUPATIONAL DEATH ANNUITY
weekend or holiday, when they are mailed on PAYMENTS
the last working day before the 19th. If your All SERS benefits are exempt from state in-
payment is mailed directly to your home, al- come tax under Illinois law. The occupational
low ten working days for delivery. death benefit annuity is not subject to federal
If you have not received your payment tax, but the survivor and widow annuities are.
after ten working days, call SERS. Failure to If your federal tax withholding informa-
advise SERS of an address change may result tion is not on file with SERS, taxes are with-
in a delayed payment.
12 13
held using the rate for a married person with
three exemptions. (See the sample W-4P on LUMP SUM
page 24.)
Each year, the Comptroller’s office is
DEATH BENEFITS
required to send you a 1099-R form showing
the total annuity amount you received for the
past year, as well as any taxes withheld. Use
BEFORE RETIREMENT
the 1099-R when preparing your income tax
return. (See the sample 1099-R on page 25.) WITH SURVIVOR ANNUITY
If an active employee dies and a monthly sur-
INCREASES FOR SURVIVOR, WIDOW, vivor annuity is payable, the nominated ben-
Refer to your annual
OCCUPATIONAL DEATH BENEFIT eficiary on file with SERS receives a lump sum Benefit Statement for
RECIPIENTS death benefit. The lump sum death benefit specific information
If you receive a monthly annuity from SERS consists of the member’s retirement contribu- about the amounts
due to the death of an active, inactive, or tions and interest. that will be paid to
retired state employee, you will receive a 3% The named beneficiary may choose to your beneficiary/
increase on January 1 following on full rollover the payment and defer tax on it
survivor after your
year of payments. Future increases of 3% until a later date. If all or part of a lump sum
will be made each January 1 thereafter. death.
payment is rolled-over, you will receive a
1099-R form by January 31, which reflects the
SURVIVOR EMPLOYMENT amount rolled-over. (Refer to the Tax bro-
The only employment restriction for individu- chure for more information.)
als receiving a survivor, widow, or occupa- The Comptroller’s office is required to
tional death benefit from SERS is for disabled, send you an IRS form 1099-R by January 31
unmarried children over age 18. This benefit of the year following receipt of this payment.
is payable if the disabled child is not gainfully The 1099-R shows the taxable portion of the
employed and earning more than $2490 per lump sum benefit, the portion attributable to
quarter. capital gains and ordinary income, and any
tax withheld. (See the sample form 1099-R
on page 25.)
WITHOUT SURVIVOR ANNUITY
If an active employee dies without a payable
monthly survivor annuity, the nominated
beneficiary on file with SERS receives a lump
14 15
sum death benefit. The payment consists of
all the member’s contributions plus interest,
and one month’s salary for each year of ser-
vice, up to a maximum of six months’ salary.
The named beneficiary may choose to
rollover the payment and defer tax on it until
a later date.
If all or part of a lump sum distribution is
rolled-over, you will receive a 1099-R form by
January 31 of the following year, which
reflects the amount rolled-over. Refer
to the Tax brochure for more informa-
tion.
The Comptroller’s office is required to
send you a 1099-R by January 31 of the year
following the receipt of this payment. The
APPENDIX
1099-R shows the taxable portion of the lump
4.
sum benefit received, the portion attributable
to capital gains and ordinary income, and any
taxes withheld. (See the sample form 1099-R
on page 25.)
AFTER RETIREMENT
If a retired SERS member dies with no payable
If a retired SERS survivor annuity, the nominated beneficiary-
(ies) receive any contributions and interest
member dies with
remaining in the retiree’s account, or $500,
a payable survivor whichever is greater.
annuity, then no The Comptroller’s office is required to
lump sum death send you a 1099-R by January 31 of the year
benefit is issued. following the receipt of this payment. The
1099-R shows the taxable portion of the lump
sum benefit received, the portion attributable
to capital gains and ordinary income, and any
taxes withheld. Refer to the Tax brochure for
more information. (See the sample form
1099-R on page 25.)
16 17
PLAN DOCUMENT SERS FUNDING
This handbook attempts to describe SERS Contributions are made by the State and its
benefits in nontechnical language. The of- members. All contributions not required for
ficial document describing SERS benefits is current operations are invested by the Illinois
the Illinois Compiled Statutes, 40 ILCS 5/14, State Board of Investment for the exclusive
which legally governs the operation of the benefit of our members and their beneficia-
plan. If there is any variance between this ries.
The State Employees’ handbook and the plan document, the plan To safeguard the proper operation and
Retirement System document will rule. funding of this multi-billion dollar pen-
is a defined benefit sion fund, operations are monitored both
plan governed by BOARD OF TRUSTEES internally and externally. SERS’ financial and
The Board of Trustees is responsible for the administrative activities are subject to an
Section 401(a) of annual audit by an independent accounting
operation of SERS. Some trustees serve on the
the Internal Revenue Board because of their position in State gov- firm under the direction of the state’s Auditor
Code. In a defined ernment. Others are appointed by the Gover- General.
benefit plan, the nor because of their particular expertise. Still Proper funding includes an actuarial
amount of your others are elected by you, our members. They review of the fund balances to ensure that
are as of January, 2008: funds will be available for current and future
retirement benefit is
benefit payments.
based on your final Gordon John Mazzotti, Chairman, appointed
average compen- by the Governor. EMPLOYER IDENTIFICATION
sation and years of John Frigo representing Ginger Ostro, NUMBER
service credit. Director, Office of Management & Budget. The Employer Identification Number of
SERS is 37-1026227.
Loren Iglarsh representing Daniel Hynes,
State Comptroller. PLAN YEAR
For record-keeping purposes, the plan year
Michele Cusumano, state employee appointed is July 1 through June 30.
by the Governor.
Joyce King, elected annuitant. LEGAL PROCESS
Legal process may be served on SERS’
Lori Gaston, elected state employee. Executive Secretary.
ADMINISTRATION EMPLOYMENT RIGHTS
SERS is administered by the board-appointed Membership in SERS does not guarantee a
Executive Secretary. right or claim to any benefit not accrued
under the terms of the plan document.
18 19
GLOSSARY OF TERMS Credited Service: The total service certified
to a member’s record.
Defined Benefit Plan: Provides a predeter-
mined benefit amount using a formula com-
Automatic Increase in Retirement Annuity: bining credited service and salary.
A 3% increase of a member’s retirement an-
nuity each January 1 following the first full Direct Deposit: By choosing Direct Deposit,
year of retirement, or age 60, whichever is you benefit is electronically deposited into
later. Under the Rule of 85, the increase is paid your bank account.
on January 1 following the first full year of
retirement, regardless of age. Final Average Compensation (FAC):
For alternative formula members, the 3% in- For Retirement and Survivor Benefits – Final
crease is paid on January 1 following the first Average Compensation is the 48 highest con-
full year of retirement or age 55, whichever is secutive months of service within the last 120
later. months of service. For alternative formula
For survivor, widow or occupational death employees, FAC is the final rate of pay or final
annuity, a 3% increase is paid on January 1 48 months, whichever is higher.
following one full year of benefits. For Death and Disability Benefits – Final
Average Compensation is the rate of pay at the
Beneficiary for Lump Sum Death Benefit: date of death or disability, or the 48 highest
The beneficiary chosen by the member to re- consecutive months of service within the last
ceive SERS benefits. A beneficiary form is kept 120 months, whichever is greater.
on file with SERS.This should not be confused
with the Group Life Insurance beneficiary, or Level Income Option: An option for coor-
the Deferred Compensation beneficiary. dinated/covered members when their SERS
benefit is increased for the period before
Benefit Statement: The annual benefit state- receiving Social Security benefits. Their SERS
ment is mailed in March to SERS annuitants. benefit is reduced when Social Security ben-
This statement summarizes your account, efits begin. This option provides an income
benefits and lists your beneficiaries. leveling effect throughout an individual’s
retirement years.
COLA (Cost-of-Living Adjustment): An auto-
matic, annual 3% compounded increase to Informer: The SERS newsletter for retirees
certain benefits. and survivors that contains timely and perti-
nent information. This newsletter is usually
mailed in January, March and September.
20 21
Nominated Beneficiary for a Lump Sum Death
Benefit: The beneficiary chosen by the member to SAMPLE ANNUITY PAY STUB
receive SERS benefits. A beneficiary form is kept
on file with SERS. This should not be confused
with the Group Life Insurance beneficiary, or the
A. Indicates the month paid. G. Health and life insurance pre-
Deferred Compensation beneficiary.
B. The gross amount paid during mium paid by the state.
the current year. Year-to-date (YTD) H. Deductions from this payment
Pension: Retirement annuity paid for a member’s is from January 1 through December are listed here. They include: state
lifetime. 31. health insurance premiums for
C. Year-to-date federal tax withheld. dependent coverage; optional life
Qualified Plan: A retirement plan qualified under
D. Year-to-date non-taxable portion insurance premiums; spouse life &
the Internal Revenue Code allowing SERS and its of the annuity. If the cost of annu- child life insurance premiums; dues
members certain tax advantages. ity has been recovered, this section for ISEA, RSEA, RSPA, or AFSCME;
blank. other insurance carrier premiums;
Retirement Annuity (Pension): Monthly annuity
E. Year-to-date state tax withheld. and credit union deductions.
paid for life.
SERS benefits are not subject to Il- I. Non-taxable portion of this pay-
linois income taxes, but annuitants
Retirement Systems’ Reciprocal Act: Provides ment. This is blank if the cost of
can request state tax withholding.
continuity of pension credits for individuals who annuity has been recovered.
F. The gross amount of this annuity
have participated in more than one Illinois public J. The net amount of this payment.
payment.
employee retirement system. There are currently
thirteen retirement systems participating in the
Retirement Systems’ Reciprocal Act. They are listed
on the back of your Benefit Statement. 12 - 31 - 07 A
Rollover: Postponing taxation of distributions by B
“rolling-over” the taxable portion of the payment C
to another qualified plan, or to an Individual Re- D
E
tirement Account (IRA).
Survivor Annuity Beneficiary: A beneficiary
(spouse, child, dependent parent) designated by
statute to receive a monthly annuity upon the F
death of the member. G
H
Widow/Survivor Refund: If a member has no eli-
gible survivor beneficiary, a refund of the widow/
survivor contribution is made at retirement.
I
J
22 23
SAMPLE FORM W -4P SAMPLE FORM 1099-R
A. Exemption from withhold- C. Additional amount, if any, A. Gross amount received.
ing. Check this box if you do not you want deducted from each B. Member’s taxable portion.
want any tax withheld from your payment. If you are not having
payment. You do not have to give enough tax withheld, you may ask C. Amount qualified for capital gain treatment.
a reason for this. the payer to withhold more tax by This only pertains to a lump sum death
entering an additional amount on benefit.
B. Withholding based on speci- line 3. D. Federal tax withheld at recipient’s request
fied withholding allowances. You may need to have addi- or as required by law.
For periodic payments, withhold- tional tax withheld if you have
E. Non-taxable portion of gross distribution.
ing is automatically based on a other income such as interest,
rate for a married person claim- dividends, capital gains, rents, F. Distribution Code listed on the 1099-R
ing three allowances. If you want alimony, taxable Social Security instruction sheet sent with this form.
withholding to be based on a benefits, etc. G. Percentage of the total distribution received.
specified number of allowances, Estimate the amount you want
H. Retiree’s total cost of annuity. (This will
write the number on this line and withheld. Divide that amount by
appear on the first 1099-R only.)
check the appropriate filing status the number of payments you will
box. receive this year. Enter the addi- I. State tax withheld at recipient’s request.
tional amount you want withheld
from each payment on line 3 of
Form W-4P. A
2007
B
C D
E
F
A G H
B I
C
24 25
SAMPLE DIRECT
DEPOSIT EARNINGS
STATEMENT
A. Month of payment.
B. Gross amount received.
C. Monthly deductions and State-paid insurance.
D. Net amount received.
A
B C D
26 27
