LETTER OF INTENT
This serves as notice of my intent regarding my anticipated employment status under HB 161. I understand that I must submit this form in order to give adequate notice for any action that may be necessary regarding my retirement benefit from the _________________________________________ (Public Employees’ Retirement System/Teachers’ Retirement System). My intent is as follows: I plan to terminate my employment effective _______________________ (must be on or before June 30, 2005). I understand my retirement benefits will continue as they are now. I plan to continue working for my present employer after June 30, 2005. I understand my retirement and retiree medical benefits will be stopped as of June 30, 2005. I understand that I will make contributions to the retirement system as of July 1, 2005, and begin accruing PERS/TRS service towards an additional pension amount. I have read the information provided regarding returning to work under the Standard Option. I understand that my first retirement will be reinstated upon termination of my employment under the Standard Option. I further understand that I will be required to apply for a subsequent retirement upon termination of employment after July 1, 2005. This Letter of Intent must be returned to us by June 30, 2005. Department of Administration Division of Retirement and Benefits PO Box 110203 Juneau, AK 99811-0203 Signature of reemployed retiree: __________________________ Dated: ____________ Printed name: _______________________________________________________________ Employer name: _____________________________ Position: ______________________ System: __________________________ SSN or RIN: ______________________________
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