CITY OF TALLAHASSEE PENSION ADMINISTRATION
TERMINATION OF EMPLOYMENT PENSION ACTION REQUEST

* First Name

* Last Name

* Social Security number

Employee ID

Last Day of Pay

Phone number

* Termination Date:

Your termination date is your last paid day of employment.

* Retirement Date:

Your Retirement date will be the 1st day of the month 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:

Marital Status

Your monthly retirement check is paid at the end of each month. If you retire one day into a month; ex. (May 2nd, June 15th ), your pension payment will go into your DROP account for the month and your first retirement check will be at the end of the following month.

Personal and Sick Leave Payout

Remember: You will only be paid up to the max balance of personal leave you had when you entered the DROP.

You will be paid out for your Sick Leave according to your employment class.

Not sure
Lump Sum Payout (Payroll will Automatically withhold 25% taxes)
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 distribution of any of these accounts. You may vest them with Empower Retirement until you reach age 72 with no fees or penalties. Although you can no longer contribute to these accounts after you retire, you do retain investment control over them.

Employee Signature

Please give the Retirement Office at least 30 days notice of your intent to retire.