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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.

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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
GU-1020 Important Notice to New Benefit Recipients Request Form
MM-0002+ Member/Benefit Recipient Data Update Request Form
H0036 Retiring and Returning to Work for the Same Employer  
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

 
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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