Office of the State Comptroller
Retirement Services Division

Connecticut Municipal Employees Retirement System

Membership Information

Please provide the following information if you intend to pursue CMERS membership.

The proposed CMERS membership effective date: _______________________

The Valuation for ______________________________ should include:
(Town/Municipal Group)

1. All past service _________
2. No past service _________
3. Both _________

Valuations performed are billed individually. If a municipality requests a valuation, "with and without" past service, the municipality will be responsible for the cost of 2 valuations. A municipality with various groups to be valued is responsible for the cost of each valuation performed for each group.

The employees listed on the roster are covered by Social Security:

Yes _________
No _________

The Municipality intends to transfer defined benefit plan contributions under the municipality's current retirement system to the CMERS to offset the cost of participation.

Current Plan Description: __________________________________
Amount to be transferred: __________________________________
__________________________ _____________________
Signature Date
__________________________ _____________________
Title Telephone Number

This form should be returned with the roster of employees and the required fee to:

Office of the State Comptroller
Connecticut Municipal Employees Retirement System
55 Elm Street
Hartford, CT 06106

Attention: William Cronin

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