City of Tallahassee Retirement Notification

* First Name

* Last Name

Employee ID

* Employee Email

* Termination Date:

Your termination date is your last paid day of employment.

* Retirement Date:

Your retirement date is the day immediately following your termination date.

Work:

Home:

Cell:

Department
Please Select... ADMINISTRATION & PROFESSIONAL SVCS AUDITING AVIATION BLUEPRINT ADMINISTRATION/INFRASTRUCTURE CAPITAL REGIONAL TRANSPORTATION PLANNING AGENCY (CRTPA) CDA ADMINISTRATION/CDA COMMUNICATIONS CITY ATTORNEY CITY COMMISSION/OFFICE OF THE MAYOR COMMUNICATIONS COMMUNITY BEAUTIFICATION & WASTE MANAGEMENT CUSTOMER SERVICES DIVERSITY & INCLUSION DOWNTOWN IMPROVEMENT AUTHORITY OPERATIONS (DIA) EMERGENCY PREPAREDNESS & FACILITIES SECURITY ENERGY SERVICES - ELECTRIC & GAS ENVIRONMENTAL SERVICES & FACILITIES ETHICS EXECUTIVE SERVICES FIRE FLEETMANAGEMENT GROWTH MANAGEMENT HOUSING & HUMAN SERVICES HUMAN RESOURCES AND WORKFORCE DEVELOPMENT MINORITY/WOMEN/SMALL BUSINESS ENTERPRISE (MWSBE) OFFICE OF ECONOMIC VITALITY PARKS, RECREATION & NEIGHBORHOOD AFFAIRS PLANNING, LAND MANAGEMENT & COMMUNITY ENHANCEMENT (PLACE) POLICE REAL ESTATE STARMETRO SUSTAINABILITY & COMMUNITY PRESERVATION TECHNOLOGY & INNOVATION TREASURER-CLERK UNDERGROUND UTILITIES & PUBLIC INFRASTRUCTURE NON-CLASSIFIED

* Department Contact:

Department Contact Phone:

Department Contact Email:

Type

Pension Plan

Termination and Retirement Date

Remember, you will be going from a bi-weekly pay period as an active employee to a monthly payment as a retiree. Your monthly pension benefit is paid at the end of each month.

* Marital Status

Are you legally married? YesNo

Spouse's name:

DOB:

SSN:

Work Schedule

M-F, 8-5Other, please specify

Buyback Service

Do you have service that you are eligible to purchase? YesNo

Personal & Sick Leave

Not sure
Payout (There will be a 25% federal withholding.)
Rollover into a tax deferred savings account

MAP 401(k)RSVP 457

Health Insurance/Benefits

Eligible for Medicare? YesNo

Do you currently have City Health Insurance? YesNo

Health Insurance is the only benefit you can add outside of the open enrollment period

Do you plan to continue City Health Insurance or pick it up at retirement? YesNoNot sure

Empower Retirement Tax Deferred Savings Accounts
MAP 401(k), RSVP 457, Police/ Firefighters Supplemental Share Plan

You are not required to take a distribution of any of these accounts. You may continue to vest them with Empower Retirement until you reach age 72 with no penalties. Although you can no longer contribute to these accounts after you retire, you do retain investment control over them.

Employee Signature