INSTRUCTIONS: ALABAMA STATEMENT OF SERVICE (Form ERS SS)

To purchase credit for service for your retirement account as an Alabama public employee, file the document discussed in this article. This form can be obtained from the website of the Retirement Systems of Alabama.

Alabama Statement Of Service ERS SS Step 1: On the first blank line, enter your first name, middle name and last name.

Alabama Statement Of Service ERS SS Step 2: On the second blank line, enter your P.O. box number or street address.

Alabama Statement Of Service ERS SS Step 3: On the third blank line, enter your city, state and zip code.

Alabama Statement Of Service ERS SS Step 4: On the fourth blank line, enter your Social Security number.

Alabama Statement Of Service ERS SS Step 5: Check the box next to the first statement if you have not established credit with any other public retirement system for the service being claimed credit for with the Employees' Retirement System of Alabama. By checking this statement, you are agreeing to notify the Employees' Retirement System of Alabama if you become entitled to credit or benefits for the service being claimed with any other public retirement system at the time of your retirement. By checking this statement, you also agree that if you do receive credit or benefits for the service being claimed from any other public retirement system at the time of your retirement, the purchased service credit will be withdrawn and you will be refunded the fee paid for this credit.

Alabama Statement Of Service ERS SS Step 6: Check the box next to the second statement if you have established credit with another public retirement system for the service for which you are claiming credit with the Employees' Retirement System of Alabama.

Alabama Statement Of Service ERS SS Step 7: Enter your signature on the next blank line.

Alabama Statement Of Service ERS SS Step 8: Enter the date on the next blank line.

Alabama Statement Of Service ERS SS Step 9: The form should be certified by a notary public, who will affix their seal, enter their signature and provide the date on which their commission expires.

Alabama Statement Of Service ERS SS Step 10: Mail the form to the address given at the top of the page.