Section 6 - IMRF

REQUEST FOR REFUND OF
VOLUNTARY ADDITIONAL CONTRIBUTIONS (VAC)
IMRF Form VARF (11/2013)
Exhibit 6ZZ
NOTE: Effective February 1, 2014, if a member continues working for his or her IMRF employer and wishes to take a
refund of VAC, only the VAC, without the interest, can be withdrawn. The interest must stay on deposit until the member
stops working for his or her IMRF employer. The interest will continue to earn interest until the member withdraws it after
terminating employment. At retirement, a member may annuitize his or her VAC if the account balance is $4,500 or more.
SECTION 1 — MEMBER INFORMATION
LAST NAME FIRST NAME MIDDLE INITIAL JR., SR., II, ETC. SOCIAL SECURITY NUMBER
Rowe James _______ 0 0 0 - ______ 0 0 - 0 _______ 0 0 0
HOME STREET (MAILING) ADDRESS
SECTION 2 — STANDARD VAC PROCESSING INFORMATION
• If there is a portion of your refund eligible for a rollover, IMRF will send you the required notifications and forms
before your claim is approved.
• This is NOT a regular savings account so there may be a delay in processing your request. IMRF will not process
your VAC refund until all contributions for the period being refunded have been reported.
Examples:
• Refund through 12/31 of last year will not be processed until all VA Contributions, including the month of
December, have been reported to IMRF (typically received by mid-January.)
• Refund through date chosen will not be processed until IMRF has received all VA Contributions through
the date specified on this application (typically received by mid-month following the final date of the plan.)
CHOOSE OPTION A OR B BELOW AND PROVIDE APPROPRIATE SIGNATURE(S)
MEMBER SIGNATURE (WRITE; DO NOT PRINT)
MEMBER SIGNATURE (WRITE; DO NOT PRINT)
IMRF Form VARF (11/2013)
DATE (MM/DD/YYYY)
DATE (MM/DD/YYYY)
OPTION B - CURRENT-YEAR REFUND WITH SUSPENSION OF VA CONTRIBUTIONS
Through ________________________________, I request a refund of my Voluntary Additional
DATE OF LAST PAYCHECK WITH VAC (MM/DD/YYYY)
Contributions and interest, including VAC made in the current year. I acknowledge that I will not
be allowed to enroll in Voluntary Additional Contributions again until January of next year.
MEMBER SIGNATURE (WRITE; DO NOT PRINT)
X
SIGNATURE OF AUTHORIZED AGENT (REQUIRED TO STOP VA CONTRIBUTIONS)
X
CITY, STATE AND ZIP
123 Oak Street Anywhere, IL 60000
COUNTY DATE OF BIRTH (MM/DD/YYYY) DAYTIME TELEPHONE NUMBER (w/ Area Code)
Everywhere 09/06/1956 ( 0 0 0 ) 0 0 0 - 0 0 0 0
YOUR EMPLOYER (Required) EMPLOYER NO. (If known) HOME TELEPHONE NUMBER (w/ Area Code)
Village of Anywhere 0 0 0 0 0 ( 0 0 0 ) 0 0 0 - 0 0 0 0
OPTION A - PREVIOUS-YEAR REFUND WITH CONTINUED VA CONTRIBUTIONS
X
X
I request a refund of my Voluntary Additional Contributions and interest through December 31 of
the previous year. I wish to continue making Voluntary Additional Contributions in the
current year.
11/21/2013
DATE (MM/DD/YYYY)
DATE (MM/DD/YYYY)
Illinois Municipal Retirement Fund
2211 York Road Suite 500 Oak Brook, IL 60523-2337
Member Services Representatives 1-800-ASK-IMRF (1-800-275-4673) Fax: (630) 706-4508
www.imrf.org