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Application and Certification for Out-of-State Service
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Form Instructions
INSTRUCTIONS: ALABAMA APPLICATION AND CERTIFICATION FOR OUT-OF-STATE SERVICE CREDIT
Members of the Retirement Systems of Alabama or of the Teachers' Retirement System with 10 years' contributing membership service or more may purchase up to 10 years of out-of-state service in the same capacities by filing the form discussed in this article. It can be obtained from the website maintained by the Retirement Systems of Alabama.
Alabama Application And Certification For Out-Of-State Service Credit Step 1: Part I should be completed by you. Enter your full name on the first line.
Alabama Application And Certification For Out-Of-State Service Credit Step 2: On the second line, enter your date of birth.
Alabama Application And Certification For Out-Of-State Service Credit Step 3: On the third line, enter your Social Security number.
Alabama Application And Certification For Out-Of-State Service Credit Step 4: On the fourth line, enter your home phone number.
Alabama Application And Certification For Out-Of-State Service Credit Step 5: On the fifth line, enter your street address or P.O. box.
Alabama Application And Certification For Out-Of-State Service Credit Step 6: On the sixth line, enter your work phone number.
Alabama Application And Certification For Out-Of-State Service Credit Step 7: On the seventh line, enter your city, state and zip code.
Alabama Application And Certification For Out-Of-State Service Credit Step 8: If you know your RSA account number, enter it on the eighth line.
Alabama Application And Certification For Out-Of-State Service Credit Step 9: On the ninth line, enter the name of the out-of-state employer. A separate form must be submitted for each one.
Alabama Application And Certification For Out-Of-State Service Credit Step 10: On the tenth line, enter the total duration of service.
Alabama Application And Certification For Out-Of-State Service Credit Step 11: On the eleventh line, note whether or not you were covered by a public retirement system or plan.
Alabama Application And Certification For Out-Of-State Service Credit Step 12: On the twelfth line, note if you are entitled to receive any benefit based on this service other than Social Security. If yes, note what kind on the thirteenth line. Sign Part I.
Alabama Application And Certification For Out-Of-State Service Credit Step 13: Part II should be completed by an official of your out-of-state employer, while Part III should be completed by a representative of your out-of-state retirement plan.
INSTRUCTIONS: ALABAMA APPLICATION AND CERTIFICATION FOR OUT-OF-STATE SERVICE CREDIT
Members of the Retirement Systems of Alabama or of the Teachers' Retirement System with 10 years' contributing membership service or more may purchase up to 10 years of out-of-state service in the same capacities by filing the form discussed in this article. It can be obtained from the website maintained by the Retirement Systems of Alabama.
Alabama Application And Certification For Out-Of-State Service Credit Step 1: Part I should be completed by you. Enter your full name on the first line.
Alabama Application And Certification For Out-Of-State Service Credit Step 2: On the second line, enter your date of birth.
Alabama Application And Certification For Out-Of-State Service Credit Step 3: On the third line, enter your Social Security number.
Alabama Application And Certification For Out-Of-State Service Credit Step 4: On the fourth line, enter your home phone number.
Alabama Application And Certification For Out-Of-State Service Credit Step 5: On the fifth line, enter your street address or P.O. box.
Alabama Application And Certification For Out-Of-State Service Credit Step 6: On the sixth line, enter your work phone number.
Alabama Application And Certification For Out-Of-State Service Credit Step 7: On the seventh line, enter your city, state and zip code.
Alabama Application And Certification For Out-Of-State Service Credit Step 8: If you know your RSA account number, enter it on the eighth line.
Alabama Application And Certification For Out-Of-State Service Credit Step 9: On the ninth line, enter the name of the out-of-state employer. A separate form must be submitted for each one.
Alabama Application And Certification For Out-Of-State Service Credit Step 10: On the tenth line, enter the total duration of service.
Alabama Application And Certification For Out-Of-State Service Credit Step 11: On the eleventh line, note whether or not you were covered by a public retirement system or plan.
Alabama Application And Certification For Out-Of-State Service Credit Step 12: On the twelfth line, note if you are entitled to receive any benefit based on this service other than Social Security. If yes, note what kind on the thirteenth line. Sign Part I.
Alabama Application And Certification For Out-Of-State Service Credit Step 13: Part II should be completed by an official of your out-of-state employer, while Part III should be completed by a representative of your out-of-state retirement plan.
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