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Fund Forms

Application For Membership (PDF)
Membership application.

Application For Retirement Package (PDF)
Application for retirement to be submitted 60 days prior to retirement.

Automatic Dues Payment (PDF)
To instruct your bank to pay your dues automatically.

Change of Address (PDF)
To be completed and submitted every time your address & contact information changes.

Change of Beneficiary (Prior to Retirement) (PDF)
Change of Beneficiary notice.

Leave of Absence Request (PDF)
Form used to request a leave of absence

Non-Vested Death Benefit (PDF)
An application form is submitted by the designated beneficiary upon the death of a member before benefits have commenced.

Part Time Creditable Service Affidavit (PDF)
Required form for part-time firefighters to certify their service.

Purchase of Prior Service Application (PDF)
To be completed and submitted when applying for “Buy Back” time.

Refund Request (PDF)
Used to submit a refund when no longer a member of the pension fund.

Request For Hearing Form (PDF)
Form used to request a hearing before The Board of Trustees

Retirement Application Form (PDF)
An application for retirement form to be submitted 60 days prior to retirement.

Retiree Beneficiary Information (PDF)
Used to select your retirement option and name your beneficiary.

Retiree Direct Deposit (PDF)
Used to arrange for the automatic deposit of your retirement benefit to your bank account.

Retiree instructions for Northern Trust (PDF)
Instructions for logging into Northern Trust

Social Security Determination Letter (PDF)

Tax Withholding Request and W-4P Certificate (PDF)
Used by retirees or surviving beneficiaries to have state and/or federal tax withheld from their benefit payment

Transfer Form (PDF)
Used by members when transferring their service from one department to another.

Volunteer Service Affidavit (PDF)
Required form for volunteer firefighters to calculate and certify their service.

Department Forms

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