HomeMy WebLinkAboutWillis Wood RetirementT E >F A. Sr M U N I C I P A L R E T
R E M E N T S Y S T E M
R U Y— B A C K A P P L I C A T i 0 N
I. WILLIS L. WOOD
HEREBY CERTIFY. THAT IT
CITY NO, 005069 S.S,NO,
jS MY DESIRE 7p R
RETIREMENT SYSTEM• IN A UMp..DEPOSIT IN THE TEXAS MUNICIPAL
L SUM PAYMENT, THE AMOUNT PREVIOUSLY WITH
THE TERMINATION OF PREVIOUS MEMBERSHIP DRAWN AT
S� PLUS
PERCENT 15%) OF SUCH'AMOUNT PER ANNUM q WITHDRAWAL CHARGE'
HARGE OF FIVE.
OF REDEPOSITS FROM THE GATE OF WITHDRAWAL TO THE DATE
I SHALL THEREUPON BE ENTITLED TO CREDIT FOR p
MONTHS OF R
C ED TABLE ICE 4 ADDITIONAL
SERV :
I THE REQUIRED LUMP-
SUM PAYMENT ISI
1. THE AMOUNT OF DEPOSITS PREVIOUSLY WIT
2• THE AMOUNT OF 2A?..66 WITHDRAWN •
S WITHDRAWAL CHA
AS OF 07-31-7b RGE ACCRUED
S 166.07'
3• THE ADDITIONAL WYTHDRAWA
DATE OF L CHARGE FROM
07-31-76 70 R
f EDEPOSIT
-- MONTHS AT S
1.18 EACH
HE TOTAL WITHDRAWAL CHARGE -�► .yam`
S, TOTAL.. LUMP—
SUM PAYMENT REQUIRED
I FURTHER��7• ��
CERTIFY TO THE FO
LLOWINGi
A• I WAS AN EMPLOYEE OF
Started to Work THE CITY OF GEORGETOWN
AND for the City on 3/10/69 ON 7 2
B. HAVE AT LEAST TWENTY—FOUR (24) CONS
ECU MONTHS OF CREDITAALE SERVICE
WITH THE CITY OF GEORGE701vN
MEMBERSHIPSINCE REESTABLISHMENT OF
IN THE TEXAS MUNICIPAL RETIREMENT SYSTEM,
I UNDERSTAND THAT THE wiTHpRAwal CHARGE WILL BE CREDITED TO OR FUT THE CITY$S
ACCOUNTS AND I WILL HAVE NO PRESENT
OR ANY BENEFIT TO BE DERIVED FROM IT, URE RIGHT TO THIS WITHDRAWAL CHARGE
WITNESSED 8Yi 1
• g'' .. NEO i
2,
• DATE, ......1. ,�z".�..7
(WITNESSES NEEDED ONLY WHEN iX) ISS
U ED FOR SIGNATURE)