ࡱ> LOKc 4bjbjBB A6 f f 9::8D4'tC/l}8K'M'M'M'M'M'M'$d),q'91//11q'4'[&[&[&1FK'[&1K'[&[&[&R"wF[&7''0'[&,R,[&,[&Z@[&O4q'q' L'1111,: E: DISTRICT ATTORNEY RETIREMENT OPTION FORM STATE OF MAINE - BUREAU OF HUMAN RESOURCES NAME  FORMTEXT       SOCIAL SECURITY #  FORMTEXT     -  FORMTEXT    -  FORMTEXT     DEPARTMENT  FORMTEXT       CLASS TITLE  FORMTEXT       In accordance with Title 5 MRSA, 17652 (and by Opinion of the Maine Attorney General 81-63), membership in the Maine Public Employees Retirement System (MainePERS) is optional for employees who: (a) are elected or appointed for a fixed term; or (b) are appointed to serve at the pleasure of the appointing authority. fb88 law requires that these employees must make an election at the time of original hire whether to be a member of the fb88PERS. Once an election is made, the election is irrevocable with respect to all subsequent employment with the same employer in a position with optional membership. STEP 1 (Complete only if you have never exercised this option at any time in the past. If you have already made this choice at any time in the past, that choice must remain in effect and you must skip to Step 2-A or 2-B below, whichever is applicable.): I understand that I must elect whether to join the fb88PERS. I also understand that this election is irrevocable with respect to all subsequent employment with the State in a position with optional membership. Therefore, I elect the following (check only one):  FORMCHECKBOX  to join the fb88PERS (go to STEP 2-A below).  FORMCHECKBOX  to not join the fb88PERS (go to STEP 2-B below).  STEP 2-A (complete only if you have elected to join the fb88PERS now or any time in the past): I understand that I may elect to have the State pay a portion of my contribution to the fb88PERS (currently that portion is 6.5% of 7.65%), or I may elect to pay my own contribution to the fb88PERS. I also understand that this election must remain in effect for the duration of my appointment. Therefore, I elect the following (check only one):  FORMCHECKBOX  to have the State pay a portion of my contribution to the fb88PERS (currently the portion paid is 6.5% of 7.65%; the remaining 1.15% will be deducted from my biweekly pay and remitted to the fb88PERS).  FORMCHECKBOX  to pay my own contribution to the fb88PERS (currently 7.65%).  STEP 2-B (complete only if you elected to not join the fb88PERS now or any time in the past): I understand that I must join a federally approved retirement plan. Therefore, I elect the following (check only one):  FORMCHECKBOX  to join the federal Social Security system.  FORMCHECKBOX  to join one of the States deferred compensation plans and to contribute at least 7.5% of my salary to that plan.  ________________________________________________________________________ ____________________________ (Employees Signature) (Date) _____Employee Copy _____Controllers Office/BHR Copy _____fb88PERS Copy     PER 117-DA 03/20 MD1XELECT   $:FHJNPRnt   f h | ~ μo!jh)h5W5U\ h)5\jh)5U\!jhzFhq<5U\jhzF5U\ hzF5\ h" .5\ hS*5\hgQ5CJ\aJhS*5CJ\aJh" .5CJ"\aJ(h" .hS*5CJ"\aJ(h" .h" .5CJ"\aJ('R  & ( @ ekd$$Ifl0* 4 lap $$Ifa$$a$       " $ & ( > @ B L N b ִݭݛ݊yyyyyݦݛ jhzF5U\mHnHu!jhzFhq<5U\jhzF5U\ h" .5\ hS*5\!jh)h5W5U\!jh)h5W5U\ h)5\ hzF5\jh)5U\ jh)5U\mHnHu.@ B t v x  5 xxxoo$ a$ $ a$gdIOP$a$gdIOP$a$ekdN$$Ifl0* 4 lap $$Ifa$ b d f h j l n p r t v x  5 ! } ǽ{{skc[ch3Ah+`6h3AhgQ6h3AhgQ5h3Ah\Z5 hzhS*hzhF{=6>*hzhsY_6>*h$h$>*h$hsY_>* hzhsY_h+`hIOPCJ hzhIOPhzhIOP5\hS* hS*5\ jhzF5U\mHnHujhzF5U\!jhzFhq<5U\#  =^ Ry|¾··”}v¾”¾ hzhzFjh5WUh)jh)U hzhsh3Ah26h3AhF{=6>*h3Ah26>* hzh2h$ hzh\Zh3Ah\Z5h3Ah+`6h3Ah+`56>*h3AhIx6h3AhgQ6h3AhgQ56>*- 789:w$ a$nkd$$Ifl*+ t0644 lap yt3A$ $Ifa$gd3A   '*789:BCMQfm{ :bc ޺޳޺~~޺vrrh)h3Ah26h3Ah26>*h3AhgQ6h3Ahz56>*h3Ahz6h3Ahz5h3Ah\Z5 hzhz hzh2 hzhsh$ hzhFh3Ah\Z56>* hzh\Z hzhzFjh)Ujh5WU,+,-.h_$ a$nkd $$Ifl*+ t0644 lap yt3A$ $If^`a$gd3A$ $Ifa$gd3A     Ps )+,-.67AEX[\nʿα壛xh3Ah+`6h3Ahz56>*h3Ahz6h3Ahz5h3Ah25 hzhz hLhIOP hzh2 hzhzFj h5WUh) hzhsh3Ah$6h3Ah\Z6 hzh\Zjh)Uj<h5WU, ".=DFGHIWXYZ 5I[\aov{}ˮ˜˜˜˧ˠh;5jh;5UhgQ hzhS* hzh-h+`hsCJhgQh$CJ j. h5WU hzhsjR h5WUh)jh)U hzhzF hzh2h3Ah268FG5[\wwwj $ a$$ a$nkd $$Ifl*+ t0644 lap yt3A$ $Ifa$gd3A \44444gdz$$dNa$gdz$ a$gdz444444 hzhS*Uh+` h+`5\ hL5\hzh+`5\h?h%1jh;5Uh;5 ? 0P&P:pz/ =!"#$% DpDNAMEEnter your name.D  SSN_first_3<Enter the first three digits of your social security number.D  SNN_second_2AEnter the fourth and fifth digits of your social security number.D  SSN_final_4:Enter the last four digits of your social security number.$$If!vh#v:V l 5/ 4pD DepartmentEnter Department name.DText1Enter Job Class Title$$If!vh#v:V l 5/ 4pDeCheck1>I choose to join the Maine Public Employees Retirement System.DeCheck2BI choose not to join the Maine Public Employees Retirement System.$$If!vh#v+:V l t065+p yt3ApDeCheck3~I choose to be paid from the standard salary schedule and to have the State pay a portion of my contribution to the MainePERS.$DeCheck4XI choose to be paid a 5% salary premium and to pay my own contribution to the MainePERS.$$If!vh#v+:V l t065+p yt3ADeCheck54I choose to join the federal Social Security system.hDeCheck6zI choose to join one of the State's deferred compensation plans and to contribute at least 7.5% of my salary to that plan.$$If!vh#v+:V l t065+p yt3Aw2&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@6666_HmH nH sH tH 8`8 Normal_HmH sH tH DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List 4@4 Header  !4 @4 Footer  !<< Default TextCJaJj#j \Z Table Grid7:V0PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VGRU1a$N% ʣꂣKЛjVkUDRKQj/dR*SxMPsʧJ5$4vq^WCʽ D{>̳`3REB=꽻Ut Qy@֐\.X7<:+& 0h @>nƭBVqu ѡ{5kP?O&Cנ Aw0kPo۵(h[5($=CVs]mY2zw`nKDC]j%KXK 'P@$I=Y%C%gx'$!V(ekڤք'Qt!x7xbJ7 o߼W_y|nʒ;Fido/_1z/L?>o_;9:33`=—S,FĔ觑@)R8elmEv|!ո/,Ә%qh|'1:`ij.̳u'k CZ^WcK0'E8S߱sˮdΙ`K}A"NșM1I/AeހQתGF@A~eh-QR9C 5 ~d"9 0exp<^!͸~J7䒜t L䈝c\)Ic8E&]Sf~@Aw?'r3Ȱ&2@7k}̬naWJ}N1XGVh`L%Z`=`VKb*X=z%"sI<&n| .qc:?7/N<Z*`]u-]e|aѸ¾|mH{m3CԚ .ÕnAr)[;-ݑ$$`:Ʊ>NVl%kv:Ns _OuCX=mO4m's߸d|0n;pt2e}:zOrgI( 'B='8\L`"Ǚ 4F+8JI$rՑVLvVxNN";fVYx-,JfV<+k>hP!aLfh:HHX WQXt,:JU{,Z BpB)sֻڙӇiE4(=U\.O. +x"aMB[F7x"ytѫиK-zz>F>75eo5C9Z%c7ܼ%6M2ˊ 9B" N "1(IzZ~>Yr]H+9pd\4n(Kg\V$=]B,lוDA=eX)Ly5ot e㈮bW3gp : j$/g*QjZTa!e9#i5*j5ö fE`514g{7vnO(^ ,j~V9;kvv"adV݊oTAn7jah+y^@ARhW.GMuO "/e5[s󿬅`Z'WfPt~f}kA'0z|>ܙ|Uw{@՘tAm'`4T֠2j ۣhvWwA9 ZNU+Awvhv36V`^PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!g theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  ,6 468; b  4 @ \4 `lr &28   H X  FFFFFFG G G G G G @ @H 0(  0(  B S  ? 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