HOME    ●    Site Map    ●    Contact US 


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

QUICK LINKS:
Home 
About Us
Disability
FAQs
Forms
Group Life Insurance
Investments
Laws/Rules/Legislation
Links
Publications
 
 
 
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 $40,000 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
CL-0897+ Cost-of-Living Adjustment Election Form 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
 GU-0002b Special Tax Notice Regarding Your Rollover Options Under Governmental 401(a) Plan Request
Form
 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.

Home  |  Disability  |  FAQs  |  Group Life Insurance  |  Investments  |  Laws/Legislation  |  Links  |  Publications  |  Site Map  |  Location/Directions  |  Contact Us

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.

Copyright © Maine Public Employees Retirement System.  All Rights Reserved.