TR-0267 (Rev. 06/12) RDA-413
Page 1 of 3
for Service Rendered
Tennessee Consolidated Retirement System
502 Deaderick Street
Nashville, Tennessee 37243-0201
For faster processing, you may complete this application through TCRS Member Self-Service at mytcrs.
com. Section 1 is to be completed by the applicant. Section 2 is to be completed by the out-of-state
employer. Section 3 is to be completed by the out-of-state retirement system.
SECTION 1. APPLICANT INFORMATION
Member ID OR
Last 4 SSN XXX-XX- Date of Birth
City State Zip Code
Email Home Phone
Position Held During Time of Service Being Claimed in Other State
Dates of Service Being Claimed through
Are you presently a member of the Tennessee Consolidated Retirement System?
Is the service being claimed established with any other pension or retirement plan?
If yes, please provide the name of that retirement system.
Applicant’s Signature Date
Before proceeding, please review the publication, “Should I Consider Purchasing Out-of-State
Service”, on the TCRS website to conﬁ rm out-of-state service will beneﬁ t your retirement. If you
have any questions about how out-of-state service is credited toward TCRS retirement, please
contact our ofﬁ ce.