ELECTION TO ACCELERATE PLAN DISTRIBUTION

 

To:       Retirement Office Supervisor

            Genesee County Employees’ Retirement System

 

I have received the Special Tax Notice Regarding Plan Payments, which explains the tax consequences of, and the direct rollover option available with respect to, my distribution from the Genesee County Employees’ Retirement System.  I understand that I have the right to consider the information provided in the Special Tax Notice Regarding Plan Payments for at least 30 days.

 

To the extent that my distribution from the Genesee County Employees’ Retirement System can be made, or begin to be made, before the close of the 30 day period beginning with the date I received the Special Tax Notice Regarding Plan Payments, I hereby waive my right to consider the contents of that notice for the full 30 day period, and I hereby consent to the making of my distribution from the Plan as soon as administratively feasible.

 

 

Date

_____________________________________________________

 

Signature of Distributee

_____________________________________________________

 

Full Name (please print)) 

_____________________________________________________

 

Social Security Number 

_____________________________________________________

 

Employer

_____________________________________________________

 

Return to:

Retirement Office Supervisor

 

Genesee County Employees’ Retirement System

 

1101 Beach Street

 

Flint, Michigan 48502-1453

 

(810) 257-2626 or (800) 949-2627