TR-0185 RDA-413
Non-Election
Waiver of Right
to Participate
Tennessee Consolidated Retirement System
502 Deaderick Street
Nashville, Tennessee 37243-0201
1-800-770-8277 http://tcrs.tn.gov
Please complete this form if you are returning to service and elect to waive
membership to TCRS upon your reemployment.
SECTION 1. MEMBER INFORMATION
Member ID Last 4 SSN XXX-XX- Date of Birth
Full Name
Mailing Address
City State Zip Code
Email Phone Number
Employer Date of Employment
I am receiving retirement benefi ts from the Tennessee Consolidated Retirement
System (“TCRS”) or a superseded state retirement system as defi ned in Tennessee
Code Annotated, Section 8-34-101. While receiving retirement benefi ts, I have
accepted employment in a position covered by TCRS. I understand that my benefi t
must be suspended upon reemployment with an employer covered by TCRS.
Pursuant to T.C.A., Section 8-36-802, I must elect whether to make contributions
to TCRS or whether to irrevocably waive my right to make further contributions and
claim retirement service credit for such period of reemployment.
I have read the foregoing and have elected to waive my right to make
contributions to TCRS while eligible for retirement benefi ts and to waive my
right to claim any retirement service credit for such period of reemployment. I
understand that this election may not be changed.
Member’s Signature Date
