Retirement Systems Forms

The following forms are in PDF format.

• Dental Form                                                                  Retiree Dental Enrollment Form
• Dental Rates                                                                 Retiree Dental Rates     
• Designation of Beneficiary Form                                      Designation of Beneficiary Form
• Federal Withholding Worksheet                                       Retirement Office Worksheet Form
• Retiree Change of Address Form                                     Retiree Change of Address Form
• State Withholding Worksheet                                          Retirement Office Worksheet Form
• W-4P                                                                            IRS Tax Withholding Form
• W-4VT                                                                          Vermont Tax Withholding Form

Teachers Forms

• Teacher Application To Purchase Service Credit       Application to Purchase Service Credit
• VSTRS Non-Medicare Medical Enrollment Form       VSTRS Non-Medicare Medical Enrollment Form
• VSTRS Medicare Medical Enrollment Form              VSTRS Medicare Medical Enrollment Form
• VSTRS Blue Medicare Rx Form                              VSTRS Blue Medicare Rx Form

State Forms

• State Application To Purchase Service Credit            Application To Purchase Service Credit
• State Retiree Medical Form                                     State Retiree Medical Form

Municipal Forms

• Municipal Application To Purchase Service Credit       Application To Purchase Service Credit