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Application for Retirement
(Retirement or Pension System)

Complete this form and return to the Employee and Retiree Service Center. Employees must be eligible for retirement as of the effective date of retirement stated below. Form must be received by ERSC 30 days prior to the effective date of retirement.

  • This form is for: Eligible Retirees
  • Form number: 455-2
  • Last revised: November 2011
Name
PDF Size
Form Number
Application for Retirement
(Retirement or Pension System)		 141 K 455-2

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For questions regarding forms, call Harriet Potosky at (301) 279-3538.

Updated November 23, 2011 | Maintained by Missy Gumula
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