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Maine Public Employees Retirement System
P.O. Box 349, Augusta, ME 04332-0349
toll free: (800) 451-9800 ● local: (207) 512-3100

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Forms - Retiree Information
       
Forms may be downloaded by clicking the corresponding form number below. The "Request Forms" e-mail is for ordering hardcopy forms only. For all other inquiries, please contact MainePERS directly.

To use these forms you will need
Adobe Reader®.  If you don't have Reader, you can get it free by clicking the link above.
Forms

 
CL-0893+ Affidavit for Estates Not Exceeding $20,000 Request Form
AC-1002+ Application for Duplicate Check Request Form
AC-0400+ Authorization Agreement for Electronic Direct Deposit Request Form
GU-1021 Confidentiality Election Form - Home Contact Information Request Form
CL-0888+ Consent Form Designating Authorized Representatives Request Form
MM-0002+ Member/Benefit Recipient Data Update Request Form
H0036-1 Information for Retired PLD Employees, Legislators and Judges Returning to Work Who Have Reached Normal Retirement Age Request
Form
H0036-2 Information for Retired State Employees and Teacher Members Returning to Work Who Have Reached Normal Retirement Age Request
Form
H0036-3 Information for Retired PLD Employees, Legislators and Judges Returning to Work Who Have Not Reached Normal Retirement Age Request
Form
H0036-4 Information for Retired State Employees and Teacher Members Returning to Work Who Have Not Reached Normal Retirement Age Request
Form
CL-0078 Social Security Benefits and MainePERS Benefits Request Form
H0032 Taxes and Your First Benefit Payment  
H0019

How the Taxable Portion of Your Service Retirement Benefit is Determined

 
 State of Maine Forms   
W-4P Withholding Certificate for Pension or Annuity Payments  
W-4ME Employees Maine Withholding Allowance Certificate  
 
+ Forms indicated with "+" may be viewed and completed on the screen using a recent version of Adobe® Reader®, printed, and mailed to the MainePERS. You may click on any line to complete that area or use TAB to move forward and SHIFT-TAB to move back. Forms cannot be saved or altered.

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Information contained on this Web site is neither a legal reference nor a complete statement of the laws or MainePERS administrative rules. In any conflict between this information and Maine laws or administrative rules, the laws and administrative rules shall prevail.

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