Pension Refund/Rollover Application

• Application for Refund/Rollover of Member’s Contributions
• Special Tax Notice Regarding Payment Plans
• Tax Notice Receipt

Completion of Application for Refund Form:

➢ Complete sections A & C for the refund check to be paid directly to you. (Please include a voided check or direct deposit authorization (must be on letterhead) from your bank.
➢ Complete sections B & C for the refund check to be directly rolled to an IRA account or another qualified plan. (Please include a separate IRA form from the institution)
➢ If you elect to roll over the pension funds to Empower Deferred Comp (457B), please complete the Incoming Transfer Direct Rollover Form. Contact Austin Maness at 901- 864-8211 for more information.

Allow up to sixty (60) days after you receive your final payouts for your refund or rollover to be distributed. If you have any questions or require additional information regarding this matter, please call us at [phone] during normal business hours.

Pension Refund Form -  https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=a5609cd7-7627-47b7-ba1a-bbff5f25347b&env=na3&acct=19cbdccc-227e-46af-a46c-0559a3cca114&v=2