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5.04e-Depart of Retirement System Status
Handle: Document-14249
Owner: Carrell, Janea (User-136, 05492:EVERETT)DS
Tuesday, January 8, 2008 11:50:03 AM PST
Friday, October 28, 2022 08:47:29 AM PDT
Modified By: Diaz, Ailienette (User-392, 08810:EVERETT)DS
Locked By:
  • Employer Signature
I have verified the information above using MRV or by contacting a DRS representative.
  • If yes, which one(s)?
c Yes, _______________________________________________________________________________________ c No If the employee checked yes,stop.
  • Contact ESS before
enrolling the employee in aDRS retirement plan.
  • • Use Member Reporting Verification (MRV) to review the employee’s retirement status.
  • • Sign and date this form.
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
5.04e DRS Retirement Status Form.pdf
4
1097620
No
Appears In: Forms
Preferred Version: 5.04e-Depart of Retirement System Status.pdf