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CERF Participant Forms

Submit all completed forms to your County Clerk. Contact your County Clerk or the CERF Administrative Office if you have any questions about the pension plan forms.

Form Number Form Name Last Revision
1 Enrollment November 16
1A Beneficiary Designation - $10,000 Death Benefit/Non-Vested Refund of Contributions July 17
  Instructions for Form 2A - Refunds Payment Election November 08
2A Refunds - Payment Election August 17
2B Retirement Application
Designation of Survivor
(Employees termed after 12/31/1999)
June 17
2C Co-Annuitant for 10 Year Certain March 09
2V Termination Vested September 17
  Instructions for Forms 3A, 3B, 3C, 4A, 4B & 4C - Death Benefits Payment Election August 12
3A Death Benefits - Non-Spouse Payment Election $10,000 Death Benefit September 12
3B Death Benefit - Spouse Payment Election $10,000 Death Benefit September 12
3C Death Benefit - Non-Designated Non-Spouse Payment Election $10,000 Death Benefit September 12
4A Death Benefits - Non-Spouse Payment Election Single-Vested/Non-Vested Refund September 12
4B Death Benefit - Spouse Payment Election Non-Vested Refund September 12
4C Death Benefits - Non-Designated Non-Spouse Payment Election Single-Vested/Non-Vested Refund April 13
5 Special Consultant June 16
6 Retirement Application
(Employees termed before 1/1/2000)
June 16
8 Beneficiary Designation - Single Vested Death Benefit July 17
9 Application by Spouse November 15
EFT Electronic Funds Transfer December 16
Fed-W4P Federal Withholding for Pension or Annuity Payments January 17
MO-W4P Missouri Withholding for Pension or Annuity Payments November 13

Submit all completed forms to your County Clerk. Contact the Empower Retirement Office at 1-877-895-1394 if you have any questions about the savings plan forms.

Form Name Last Revision
Savings Plan Enrollment June 17
401(a) Beneficiary March 17
401(a) In Service Withdrawal Age 59.5 or Older June 17
401(a) Incoming Direct Rollover June 17
401(a) Separation From Employment Withdrawal Request May 17
401(a) Death Claim May 17
457 Beneficiary March 17
457 In Service Withdrawal Age 70.5 June 17
457 Incoming Transfer June 17
457 Paycheck Contribution Election April 17
457 Death Claim June 17
457 Separation From Employment Withdrawal Request May 17

The County Fees Transmittal Form is used by County Clerks and Treasurers when remitting fees to KeyBank by check.

The County Deposit Exception Form is used by County Clerks and Treasurers to notify CERF when the expected payment amounts DO NOT equal the amount of funds submitted to KeyBank.

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