Fillable Florida Retirement System Pension Plan Application for Service (State of Florida / Dept. of management Services)

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Florida Retirement System Pension Plan Application for Service (State of Florida / Dept. of management Services)

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U.S.A. forms for State of Florida / Dept. of management Services

BROWSE STATE OF FLORIDA / DEPT. OF MANAGEMENT SERVICES (FL) FORMS

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Florida Retirement System Pension Plan
Application for Service Retirement
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
FR-11
Effective 09/18
Calculations
Rule 60S-4.0035, F.A.C.
Instructional Page 1 of 1
All of the following are required before your name can be added to the retired payroll.
1. Termination of all employment with all employers under the Florida Retirement System (FRS). If you are dually employed
with one or more FRS employer(s), you must terminate from all positions.
2. A properly completed Application for Service Retirement, Form FR-11. The FR-11 must be signed in the presence of a
notary public and approved by your employer. Since your retirement date will be determined by the date we receive the
FR-11, you should send the FR-11 to the Division of Retirement even if you do not have the other required documents.
The FR-11 will be accepted up to six months before your desired retirement date. Notify the division of any address or
telephone number changes that occur after you submit your FR-11.
3. A properly completed Option Selection for Members, Form FRS-11o. An explanation of the options is on the attached page
titled "What Retirement Option Should You Choose."
4. A properly completed Spousal Acknowledgment Form, Form SA-1. You must complete and sign the top portion in the
presence of a notary. If you are married and select option 1 or 2, your spouse should complete the bottom portion in the
presence of a notary.
5. A check payable to the Florida Retirement System for any amount you owe, or a written statement that you do not wish to
claim the service. Please put your social security number on the face of the check. You may roll over funds from a
qualified plan (IRA, deferred compensation, etc.) to pay the amount due. Form PRO-1, Pretax Direct Rollover, must be
received with the payment.
6. Proof of your birth date. If you select Option 3 or 4, you must also submit birth date verification for your beneficiary. We
will accept legible photocopies of one of the following (except for i):
a. Copy of a birth certificate
b. Delayed birth certificate
c. Valid, unexpired U.S. passport
d. Census report more than 30 years old
e. Life Insurance policy more than 30 years
f. Letter from the Social Security Administration stating the date of birth it has established for the payment of benefits
g. Certificate of Naturalization
h. Florida driver's license issued after January 1, 2010 that indicated compliance with the federal REAL ID Act
i. In the absence of one of the above, a copy of two of the following documents:
(1) Birth certificate of child, showing age of parent (limit one)
(2) Baptismal certificate more than 30 years old
(3) Hospital record of birth
(4) School record at time of entering grammar school
7. A copy of your marriage certificate if you selected option 3 or 4 and name your spouse as your joint annuintant.
8. A final certification of your earnings by your employer for the last four months of your employment. Your employer is
aware of this requirement.
9. A Statement of Military Eligibility will be mailed to you if you claim military service and the form is needed.
10. A Beneficiary Designation, Form FST-12, if designating more than one beneficiary; otherwise complete the
Beneficiary Designation section of Form FR-11.
11. Direct Deposit of your benefit is available through the state's Electronic Funds Transfer (EFT) program. An application will
be mailed to you after your name has been added to the retired payroll. If you are a state employee, currently on EFT, you
will automatically continue on EFT unless you cancel your authorization.
Florida Retirement System Pension Plan
Application for Service Retirement
PO BOX 9000 Tallahassee, FL 32315-9000
Local Phone: 850-907-6500 Toll Free: 844-377-1888 FAX: 850-410-2010
FR-11
Effective 09/18
Calculations
Rule 60S-4.0035, F.A.C.
Page 1 of 1
My services terminated, or will terminate, on . Your retirement date is determined by the
Division of Retirement.
I understand I must terminate all employment with FRS employers to receive a retirement benefit under Chapter 121, Florida
Statutes. This includes but is not limited to: part-time work, other personal services(OPS), substitute teaching, adjunct professor or
non-Division approved contractual services. I also understand that I cannot add service, change options, change my type of
retirement (Regular, Disability, and Early) or elect the Investment Plan once my retirement becomes final. My retirement becomes
final when any benefit payment is cashed or deposited.
Employer Certification: This is to certify that the above named member was employed by this agency and will terminate, or has
terminated on with the last day worked on .
Authorized Personnel Signature: Agency Number:
Agency Phone: Date:
Member Signature: (sign in the presence of a Notary)
Notary: State of
, County of . The above named person who has sworn to and subscribed
before me this day of 20 and is personally known or has produced
as identification.
Signature of Notary Public
Print, Type or Stamp Commissioned Name of Notary Public
Beneficiary Designation: All previous beneficiary designations are null and void unless you are applying for a second career
retirement benefit. In the case of a second career benefit, this application does not affect your original benefit in any way. To
designate more than one primary beneficiary, attach a Beneficiary Designation Form, FST-12.
Primary Contingent
Name Relation Name Relation
SSN DOB SSN DOB
Phone Phone
Address Address
Member Name Member SSN
Position Title Birth Date
Home Phone Work Phone
Home Mailing
Address
Present FRS
Employer(s)
Email Address
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Florida Retirement System Pension Plan Application for Service (State of Florida Dept. of management Services)

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Completed 12 July 2021

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