Policy DEBA - Exhibit 1
Issue Date: November 18, 2009
Early Retirement Application
- _______________________________________2. ________________________________
- Age as of June 30 next __________________________.
- Date of beginning service in the Juab School District _____________________________
- Fifteen years of immediate preceding service?Yes ________ No ________
- Eligible for full retirement benefits under URS?Yes ________ No ________
- I desire to take early retirement under the Early Retirement Policy of the Juab School
District adopted _________________. I have read the policy. I consider myself eligible
under the provisions of the policy. I am also familiar with the benefits due me upon my
retirement through Social Security and through the Utah State Retirement Systems. I desire
to retire July 1, 20______.
(To be completed by the District)
- Date ___________________________
- Position on salary schedule: Step ________ Lane _________
- Eligibility confirmed: _______________________________________
- Benefits in effect for the following school years:______________ ______________
______________ ______________ ______________.
Retiree Superintendent or Clerk