Fillable Printable Leoff Plan 2 Retiree Re-Employment
Fillable Printable Leoff Plan 2 Retiree Re-Employment
Leoff Plan 2 Retiree Re-Employment
*DRSL264*
DRS L 264 11/16
LEOFF Plan 2
Re-employment
This form is for members and retirees who are eligible
to enter another DRS-covered retirement plan.
Return this form to your employer.
For questions, contact:
Department of Retirement Systems
www.drs.wa.gov
ꔷ 800.547.6657
360.664.7000 ꔷ TTY: 711
Instructions
Fill in this form and return it to your employer. Your employer will send the form to DRS. If you are a Law
Enforcement Ofcers’ and Fire Fighters’ Retirement System (LEOFF) member or retiree and are eligible to enter
another DRS-covered retirement system, pick one of the Re-employment Choice options below.
If you want to retire from LEOFF Plan 2 (that is, begin receiving your LEOFF Plan 2 monthly benet) and later
return to the same employer in a different position, the law requires you to fully separate from service rst
(
WAC 415-02-115
). To do so, you must:
• Meet the age and service requirements for retirement
• File an application for retirement with the Department of Retirement Systems (DRS)
• End all employment with any DRS-covered employer(s)
• Sever all contractual agreements (written or verbal) for future employment with your DRS-covered
employer(s)
Your Social Security number is needed so DRS can report to the IRS any funds paid to you. DRS will not disclose your
Social Security number unless required to do so by law. (See IRC sections 6041(a) and 6109.)
Signature
I choose the re-employment option marked above. My full name and Social Security number are accurate.
SignatureDate
Re-employment Choice (you must pick an option)
c
Become a member of the new retirement plan.
That plan could be in the Public Employees’ Retirement System (PERS), Public Safety Employees’
Retirement System (PSERS), School Employees’ Retirement System (SERS) or Teachers’ Retirement System
(TRS). You will begin making contributions in the new plan. You will earn service credit in your new plan.
If you are already retired from LEOFF when you become a member of another retirement system, you
will temporarily stop receiving your monthly LEOFF benet. When you leave your eligible position, you
will begin receiving your LEOFF monthly retirement benet again as well as retroactive payments for the
time you were employed and contributing to the new plan. Depending on the age and service credit
requirements of the new plan, you also might be eligible for a retirement benet for that plan.
c
Don’t become a member of the new retirement plan.
You will continue receiving your monthly LEOFF Plan 2 retirement benet. You won’t make contributions
toward a second retirement benet. Nor will you earn service credit during your time in your new position.
Member or Retiree Information
Name (Last, First, Middle)Social Security Number
New EmployerEmployer Phone Number
Employers: Please forward this form to PO Box 48380, Olympia WA 98504-8380.
Clear Form
