Fillable RICHMOND RETIREMENT SYSTEM (RRS) Section 78-174 Purchase of (Port of Richmond)

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RICHMOND RETIREMENT SYSTEM (RRS) Section 78-174 Purchase of (Port of Richmond)

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Rev. 05/2010
ELIGIBILITY:
Retirement Code Section 78-174 Purchase of Prior Service
PAYMENT:
Police Officers/Firefighters: 15%
General Employees: 10%
HOW TO APPLY:
RICHMOND RETIREMENT SYSTEM (RRS)
Section 78-174 Purchase of Prior Service
Payment may be made in a lump sum or by payroll deduction in equal installments over a period not to exceed
the service credit being purchased. For each year of service to be credited the member must pay the following
percentage of their present annual compensation or the average annual compensation during the thirty-six (36)
highest consecutive months of creditable service, whichever is greater:
1. Complete Section One of the Certification of Service Form and forward to the appropriate employer(s) to
certify your employment for the period(s) of service you want to purchase. Request that the form be completed
and returned to the RRS address listed below:
2. When the RRS receives the Certification of Service Form, you will be contacted to come into the office and
complete the Service Credit Application.
Upon receipt of the above mentioned forms, the RRS will research your records and notify you as to whether
or not you are eligible to purchase service and the cost of the purchase.
If applicable, after certification, the RRS will forward your service credit application form to the City's Finance
Department for processing of payroll deductions.
2) Full-time service rendered to the City of Richmond on a temporary, seasonal, provisional, Comprehensive
Employment Training Act (CETA) or contractual basis, provided that such period has not been previously
included in the creditable service.
Any member in service who has completed five (5) or more years of creditable service may purchase credit for
service for all or part of the following:
1)
C
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the service will not be considered in the calculation of any retirement benefit by another retirement system,
and/o
r
900 East Broad Street
Room 400
Richmond, VA 23219
RICHMOND RETIREMENT SYSTEM
www.richmondgov.com/retirement
Phone 804.646.5958
Fax 804.646.5299
Rev. 05/2010
CERTIFICATION OF SERVICE FORM
Home Phone:
SECTION C: AGENCY INFORMATION (Government Agency Where this Period of Service Occurred)
Signature:
SECTION E: MEMBER SIGNATURE
PART 1: To be Completed by the Employee
Please complete this section and forward the form to your former employer to complete Part 2.
SECTION A: MEMBER INFORMATION
Work Phone:
Zip:
SECTION B: SERVICE INFORMATION (Period of Service to be Purchased)
SECTION D: RETIREMENT SYSTEM INFORMATION (Retirement System Information from this Period)
SSN:
Name of Retirement System:
I hereby authorize the RRS to obtain any information concerning my employment that may be required in
connection with my application to purchase prior service credit.
Date:
From (mm/dd/yyyy):
Address:
City: State: Zip:
Address:
To (mm/dd/yyyy):
Name of Agency:
State:City:
please type or print in ink
City: State: Zip:
Address:
Name:
Date of Birth:
The employee listed below is interested in purchasing service credit for previous employment with your agency in order to have more
service credit with the RRS. Please provide the employment information requested in Part 2 of this form and return it to the RRS at
the address listed below.
900 East Broad Street
Room 400
Richmond, VA 23219
RICHMOND RETIREMENT SYSTEM
www.richmondgov.com/retirement
Phone 804.646.5958
Fax 804.646.5299
Rev. 05/2010
From To
Yes No
Yes No
Type/Description:
Government Agency:
Title:Name:
City: State: Zip:
Address:
3. Has this individual received credit for any public, out-of-state
service from another retirement system?
I hereby certify that the above information was taken from our official records.
Signature: Date:
No Yes
PART 2: To be Completed by the Employer/Retirement System
2. Is this individual receiving or entitled to receive a benefit from
your system based on the service shown above?*
1. Was this individual ever a member of your retirement system?
Yes No
* If the answer to Question 2 is "Yes," please elaborate in the space below. We require this clarification because the Code of the
City of Richmond does not allow a member to purchase service time used in the calculation of a retirement benefit by another
retirement system.
From: To:
From: To:
Type/Description:
Total Service Credit
Counts towards retirement eligibility
List all period(s) of uncompensated leaves of absence and/or period(s) of uncompensated time.
Cost to Purchase:
Years: Months:
Certified By: Approved By:
Specify Service
Full Time or Other
Employed
Employing Agency
RRS Use Only
900 East Broad Street
Room 400
Richmond, VA 23219
RICHMOND RETIREMENT SYSTEM
www.richmondgov.com/retirement
Phone 804.646.5958
Fax 804.646.5299
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RICHMOND RETIREMENT SYSTEM (RRS) Section 78-174 Purchase of (Port of Richmond)

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Completed 4 August 2020

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