INSTRUCTIONS: ARIZONA ELECTED OFFICIALS' RETIREMENT PLAN (Form E1)

Arizona elected officials can enroll in a state administered retirement plan using a form E1. This document can be obtained from the website maintained by the Public Safety Personnel Retirement System of the State of Arizona.

Arizona Elected Officials' Retirement Plan E1 Step 1: On the first line, enter your name. Indicate your gender by circling "M" or "F."

Arizona Elected Officials' Retirement Plan E1 Step 2: On the second line, enter your marital status.

Arizona Elected Officials' Retirement Plan E1 Step 3: On the third line, enter your Social Security number.

Arizona Elected Officials' Retirement Plan E1 Step 4: On the fourth line, enter your birth date.

Arizona Elected Officials' Retirement Plan E1 Step 5: On the fifth line, enter your complete home address.

Arizona Elected Officials' Retirement Plan E1 Step 6: On the sixth line, enter your home telephone number.

Arizona Elected Officials' Retirement Plan E1 Step 7: On the seventh line, enter your email address.

Arizona Elected Officials' Retirement Plan E1 Step 8: The next section concerns your employment. If you are an employee of the state of Arizona, check the first box.

Arizona Elected Officials' Retirement Plan E1 Step 9: Check the second box if you are a county employee and circle the name of your county.

Arizona Elected Officials' Retirement Plan E1 Step 10: Check the third box if you are a town employee and enter its name.

Arizona Elected Officials' Retirement Plan E1 Step 11: Check the third box if you are a city official and enter its name.

Arizona Elected Officials' Retirement Plan E1 Step 12: Enter your position title, your membership date and your current salary on the last three lines of this section.

Arizona Elected Officials' Retirement Plan E1 Step 13: In the next section, enter your spouse's name on the first line and their birth date on the second line.

Arizona Elected Officials' Retirement Plan E1 Step 14: Enter your spouse's Social Security number on the third line, and the number of children you have under age 18 on the fourth line.

Arizona Elected Officials' Retirement Plan E1 Step 15: Enter children's birth dates on the fifth line.

Arizona Elected Officials' Retirement Plan E1 Step 16: Document previous elected official employment as directed. Sign and date the bottom of the first page. Name any beneficiaries on the second page.