Retirement Services Division Memorandum 2012-10
Attachment - Agency Certification
| Return to: | Office of the State Comptroller |
|---|---|
| Retirement Services Division | |
| Attention: Audit Unit | |
| 55 Elm St. | |
| Hartford, CT 06106 |
Pursuant to the Hazardous Duty Arbitration Award of August 22, 2012, this former employee had 20 or more years of hazardous duty service as of June 30, 2009 but was unable to take advantage of the RIP due to the interpretation of vacation accruals. The following serves as the basis for our certification of the employee's years and months of hazardous duty service as of June 30, 2009 and their accrual balance of that date.
Agency: ____________________________________________________
Employee Name:_____________________________________________
Employee Number:____________________
Date of Retirement:____________________
Please state service in years, months and days in the space provided below.
| *Actual State Hazardous Duty Service on 6/30/2009 | _____ | - | _____ | - | _____ |
| (exclude purchased medical leave) | |||||
| Accrued vacation days on 6/30/2009 | _____ | - | _____ | - | _____ |
| Total Hazardous Duty Service on 6/30/2009 | _____ | - | _____ | - | _____ |
* actual state service excludes leaves without pay
| _____________________________ | __________________ |
| Authorized Agency | Signature Date |
| _____________________________ | ___________________ |
| Print Name | Phone Number |
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