How to Write a Retirement Letter - Excel

							MSD 426 (4/10)                                    Franklin County Personnel Office                                     355 West Main Street, Suite 428
                                                                                                                             Malone, NY 12953
DATE:                                        Supplementary Payroll Certification and                                       www.franklincony.org
                                                                                                                    Phone: (518)481-1676/1665/1675/1677
                                                  Report of Personnel Change                                                 Fax: (518)483-2340
SELECT YOUR LOCATION (ONLY ONE)

County Department #:                                                                     NAME OF EMPLOYEE (Type above line)

Town of:
                                                                                         ADDRESS (Type above line)
School District:

Village of:                                                               CIVIL SERVICE TITLE                                 SALARY OR HOURLY



   NAME AND TITLE OF LAST EMPLOYEE IN POSITION                         Date of Birth         Social Security #             Retirement Reg. Number
      (IF NEW POSITION, WRITE NEW ON THE LINE
     AND SUBMIT PAPERWORK AS NOTED BELOW)                                    Veteran                               Non-Veteran
                                                                    Disabled Veteran                               Exempt Volunteer Firefighter
                   Check Nature of Personnel Change            DATE EFFECTIVE        Action necessary by appointing Officer
                   Permanent Competitive Appointment                                 Return certificate of eligibles
                   Provisional Competitive Appointment                               Attach employment application (MSD 330)
  APPOINTMENTS




                   Temporary Appointment                                             State length of employment
                   Substitute                                                        Give facts under remarks
                   For Term of Office                      From:      To:            Give facts under remarks
                   Unclassified                                                      Give facts under remarks
                   Permanent Promotion                                               Return certificate of eligibles
                   Provisional Promotion                                             Attach nomination
                   Non-Competitive Class Appointment                                 Attach employment application (MSD 330)
                   Exempt Class Appointment                                          Attach employment application (MSD 330)
                   Labor Class Appointment                                           Attach employment application (MSD 330)
                   Resignation                                                       Submit signed resignation letter
    TERMINATIONS




                   Retirement                                                        Give effective date - Submit copy of retirement letter
                   Deceased                                                          Give effective date
                   Removal                                                           Attach copy of proceedings
                   Lay-off (Lack of work or funds)                                   Give facts under remarks
                   Military Leave of Absence                                         Attach Military Orders Circle One: w/pay OR w/o pay
                   Medical Leave of Absence                                          Give facts under remarks
                   FMLA Leave of Absence                                             Give facts under remarks
                   Workers' Comp Leave of Absence                                    Give facts under remarks
  OTHER CHANGES




                   Transfer                                                          Give facts under remarks
                   Reassignment                                                      Give facts under remarks
                   Demotion                                                          Give facts under remarks
                   Suspension                                                        Give facts under remarks - Note if w/pay or w/o pay
                   Reinstatement                                                     Give facts under remarks
                   Change in Classification                                          Give date of Civil Service classification action
                   New Position                                                      Submit Resolution
                   Change in salary                                                  Indicate new salary
                   Change in name                                                    Give facts under remarks
                   Change in address                                                 Give facts under remarks
                   Other                                                             Give facts under remarks
                             IF A LICENSE OF ANY KIND IS REQUIRED ATTACH A COPY OF BOTH SIDES TO THIS FORM
REMARKS: (Continue on back if necessary)




                                                                                                   Signature and Title of Appointing Officer

FOR PERSONNEL DEPARTMENT USE ONLY                                  This certifies that the above employment is in       Date: ______________
  T _____        P13 _____    B_____                               accordance with Laws and Rules made in
 P2 _____        AS R ______ PD List ____                          pursuance to Law. Subject to any limitation          By: ________
 P9 _____        AS V ______ LT _____                              or condition specified above.
 P11 _____       Step ______  UNI _______
                 HTH _______