STATE EMPLOYEES RETIREMENT COMMISSION MEDICAL EXAMINING BOARD For DISABILITY RETIREMENT		55 ELM STREET HARTFORD, CONNECTICUT 06106-1775 Telephone (860) 702-3480 Facsimile (860) 702-3489
	STATE OF CONNECTICUT
	RETIREMENT SERVICES DIVISION OFFICE OF THE STATE COMPTROLLER

RETIREMENT SERVICES DIVISION MEMORANDUM 2012-05

April 24, 2012

TO THE HEADS OF ALL STATE AGENCIES

The purpose of this memorandum is to notify agencies that a new refund application form, CO-628d, "Application for Refund of Retirement Contributions State Employees Retirement System, Tier III Members - Non-vested Only" is now available on the Office of the State Comptroller's website.

Agencies should provide this form to employees at the time they terminate state service provided they are not eligible for a vested retirement benefit from the State Employees Retirement System (SERS) Tier III retirement plan.

An application to "cash out" retirement plan membership for terminated SERS Hybrid Plan members will also be provided in the future.

General instructions for completion are on the form. Any questions concerning this form may be directed to the Retirement Services Division's Data Base Unit by email at osc.databaseunit@po.state.ct.us or by telephone at 860-702-3515.

Very truly yours,

STATE EMPLOYEES RETIREMENT COMMISSION
KEVIN LEMBO, SECRETARY EX OFFICIO

By:

Brenda K. Halpin, Director
Retirement Services Division

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