Application (CO-898 revised 8/2015) - Original Only
Applicant's Signature ___ Agency Signature ___ Verify Date of Retirement ____
Type of Option matches form submitted ___
Verify Type of Retirement Checked off on application ___
Option Form - Original Only
| A - 50% Spouse | B - 50% / 100% | C - 10 Yr / 20 Yr | D - Lifetime |
| (CO-899 Rev 7/15) | (CO-900 Rev 11/15) | (CO-901 Rev 11/15) | (CO-902 Rev 11/15) |
|---|
The form was witnessed properly ___
The Witness is not the Annuitant and/or the Beneficiary ___
Certification of Marital Status (CO-1047 Rev. 9/15) - Original
Not Required if Electing Option A 50% Spouse or Option B Electing the Spouse
If married, verify receipt of marriage certificate ___
Verify that Parts I & III have been completed as follows:
Member's Option Election ___
Member's Signature ___
Spouse's Signature ___
Name of Annuitant
(if applicable) ___
Spouse's Initials ___
Authorized witness/if notary,
Expiration date required ___
If Single or Married less than one year, verify: ___
Completed Part I & II Authorized witness; if notary, expiration date required
___
Birth Documentation (one copy each)
Retiree Birth Certificate ___ If applicable, Annuitant Birth Certificate___
Choice of Health Services After Retirement (CO-744 Rev 7/15) -
Original Only
Copy of Medicare Card if retiree or spouse is 65 years or older
W4P (Original) ___ CT-W4P (Original) ___
Direct Deposit Form (CO-1068 Rev 7/2016) Original ___
Return to Retirement Services Division Memorandum 2016-03
Return to Index of 2016 Comptroller's Memoranda
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