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
• Retiree Direct Deposit Form                                               Retiree Direct Deposit 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
• Teacher Retiree Under 65 Medical Form                        Teacher Retiree Under 65 Medical Form
• Teacher Retiree Over 65 Medical Form                           Teacher Retiree Over 65 Medical Form
• Teacher Retiree Blue Medicare Rx Form                         Teacher Retiree 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