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Policy DEBA - Exhibit 1

Policy DEBA-Exhibit 1 (PDF)

Issue Date: November 18, 2009

 

Early Retirement Application

  1. _______________________________________2.  ________________________________

                                   Name                                                                     Birthday

  1. Age as of June 30 next __________________________.
  1. Date of beginning service in the Juab School District _____________________________
  1. Fifteen years of immediate preceding service?Yes ________  No ________
  1. Eligible for full retirement benefits under URS?Yes ________  No ________
  1. 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______.

      ______________________________________    ___________________________________

                                  Date                                                                       Signed

Approval

(To be completed by the District)

  1. Date ___________________________
  1. Position on salary schedule: Step ________  Lane _________
  1. Eligibility confirmed: _______________________________________
  1. Benefits in effect for the following school years:______________   ______________

      ______________  ______________  ______________.

  1. Approved:

_______________________________________     ____________________________________

                               Retiree                                                        Superintendent or Clerk