PERSONAL INFORMATION (PLEASE PRINT)
Security
Number
ACCOUNT(S) FROM WHICH I AM APPLYING FOR A PAYMENT (PLEASE PRINT)
Employment:
Employment:
Employment:
Employment:
Employment:
In order to be eligible for payment, you must complete a calendar month break in service, even if you are changing LAGERS
employers. If you had wages in the month you left employment, your payment will be made approximately 60-90 days from the
date of your last day of LAGERS covered employment. Checks are issued on the first of the month. All vested members who are
issued refunds after September 1
st
shall be credited with regular interest on the largest balance in such account for the entire fiscal
I UNDERSTAND THAT BY RECEIVING A REFUND OF MY EMPLOYEE CONTRIBUTION ACCOUNT BALANCE, THE SERVICE CREDIT
ASSOCIATED WITH THE PERIOD OF TIME I WAS MAKING CONTRIBUTIONS WILL BE FORFEITED. IF THE LUMP SUM PAYMENT IS PAID
TO ME, I UNDERSTAND THAT ALL SERVICE CREDIT ASSOCIATED WITH THE ACCOUNTS LISTED ABOVE WILL BE FORFEITED. NO
FUTURE MONTHLY BENEFIT WILL BE PAYABLE FROM FORFEITED ACCOUNTS.
Missouri Local Government Employees Retirement System
P.O. Box 1665, Jefferson City, MO 65102
P: 1-800-447-4334 F: 1-573-636-9671
APPLICATION FOR PAYMENTS DUE A FORMER MEMBER
This form should be used if you are no longer covered by the LAGERS system and wish to forfeit your service credit by receiving either a
refund of your employee contribution account balance or a lump sum payment of the reserve value of your deferred allowance,
pursuant to sections 70.676 or 70.690. DO NOT use this form if you desire a monthly benefit associated with the account(s) below. If
you are vested, you must be under your early retirement age (55 for general employees, 50 for police officers and fire fighters) to
request a refund of your employee contribution account balance. If you are not vested, you may request a refund of your employee
contribution account balance at any age. You are eligible for the lump sum payment if you are vested, have less than ten years of
service credit, and are more than ten years from your normal retirement age. Normal retirement age is 60 for general employees and
55 for police officers and fire fighters.
THIS FORM CANNOT BE SUBMITTED PRIOR TO YOUR LAST DAY OF LAGERS COVERED EMPLOYMENT.
IF YOU DO NOT WISH TO FORFEIT SERVICE CREDIT AND PREFER A FUTURE MONTHLY BENEFIT, PLEASE COMPLETE THE LRS-8 FORM.
