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Click ‘Get Form’ to open it in the editor.
Begin by entering your Name and SSN at the top of the form. This information is essential for identification purposes.
In Section I, if you have never been a member of a State of Florida administered retirement plan, simply check the box and provide your signature and date.
If you are a current or previous member, complete Section II by selecting your applicable retirement plan from the list provided.
Proceed to Section III if you are not retired. Read through the statements carefully and sign and date where indicated.
If you are retired, fill out Section IV with your retirement effective date and ensure you understand the implications of reemployment as outlined in this section.
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