Retirement Planning Associates - Teacher's Retirement Form


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Teacher's Retirement Benefits

Please fill in the following form for an analysis of your retirement benefits under State Teacher's Retirement System.

MEMBER:
Mr. Mrs. Ms. Miss Dr.
First Name:	Initial: Last Name:
Date of Birth:


School District:
School:
Position:
Unused sick leave (days):	Planned Retirement age: Years of Service:
Salary: (Average of 3 highest years)
Address:
City/Town:	State/Province:
Zip/Postal Code:	Country:
Home Phone:	Business Phone: Ext:
BENEFICIARY:
Mr. Mrs. Ms. Miss Dr.
First Name:	Initial: Last Name:
Date of Birth:


School District:
School:
Position:
Unused sick leave (days):	Planned Retirement age: Years of Service:
Salary: (Average of 3 highest years)
Address:
City/Town:	State/Province:
Zip/Postal Code:	Country:
Home Phone:	Business Phone: Ext:
Comments or suggestions:

Wait, I wish to my selection(s).

After you have completed this form, and we will mail you the requested information.


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Retirement Planning Associates is led by James Ellis, a registered representative of,
and securities offered through, JKR & Co., Member NASD, SIPC.