Form GEN008 "Refund Election (Pers Tier I/II/Iii, Trs Tier I/II, Jrs)" - Alaska

What Is Form GEN008?

This is a legal form that was released by the Alaska Department of Administration - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the Alaska Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form GEN008 by clicking the link below or browse more documents and templates provided by the Alaska Department of Administration.

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Download Form GEN008 "Refund Election (Pers Tier I/II/Iii, Trs Tier I/II, Jrs)" - Alaska

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Refund Election
FOR OFFICE USE ONLY
(PERS Tier I/II/III, TRS Tier I/II, JRS)
ALASKA DIVISION OF
Retirement
Benefits
and
Division of Retirement and Benefits
Juneau: (907) 465-4460
Toll-Free: (800) 821-2251
P.O. Box 110203
TDD: (907) 465-2805
alaska.gov/drb
Juneau, AK 99811-0203
Fax: (907) 465-3086
DRB USE ONLY
EMP ____________________ BAL ___________________ PMT ___________________ SE _____________________
DB PERS
SIGN ___________________ TERM __________________ MAR __________________ WAIVER ________________
DB TRS
JRS
CEXP ___________________ DB 101 _________________ QDRO / CSED FLAG ______________________________
(CHECK ONE)
Public Employees’ Retirement System
Teachers’ Retirement System
Judicial Retirement System
SECTIONS A, B, C (IF APPLICABLE), E, AND F MUST BE COMPLETED PRIOR TO PROCESSING. IF NOT, THIS FORM WILL BE RETURNED TO
THE PARTICIPANT. THIS FORM SUPERSEDES ALL OTHER REVISIONS.
SECTION A. MEMBER INFORMATION
NAME (FIRST / M.I. / LAST)
LAST 4 OF SSN OR RETIREMENT IDENTIFICATION NUMBER (RIN)
BIRTH DATE (MM / DD / YYYY)
SEX
MARITAL STATUS
DATE OF MARRIAGE (MM / DD / YYYY)
Male
Female
Married
Divorced
Single
Widowed
PERSONAL TELEPHONE NUMBER
PERSONAL EMAIL ADDRESS
DATE OF DIVORCE (MM / DD / YYYY)
MAILING ADDRESS (STREET OR P.O. BOX)
CITY
STATE
ZIP+4
We will use this to confirm we have your correct address on file. If your address is different than what we have on file, we will not use this address to update
your account and your withdrawal may be delayed. If you believe we do not have your correct address or if you need to change your address, call us at
(907) 465-4460 before submitting this form.
SECTION B. FORM OF PAYMENT REQUESTED
(Total amount withdrawn and/or direct transfer/rollover must equal 100% of account balance.)
I elect the following lump sum payment:
Payment to Participant: Percent: ________% or Dollar Amount: $____________ (20% mandatory tax will be automatically withheld)
(If you would like additional federal income tax withheld, enter additional percent at right ________%)
Direct Transfer/Rollover: Percent: ________% or Dollar Amount: $____________
For a DIRECT TRANSFER/ROLLOVER, please complete the following OR indicate “See Attached” and attach the form from a financial institution
or a new qualified plan which contains the information requested below. Attach that form with your original signature appearing on the form.
FINANCIAL INSTITUTION / PLAN NAME
ACCOUNT NUMBER (MANDATORY)
PLAN ADDRESS
CITY
STATE
ZIP+4
CONTACT PERSON
TELEPHONE NUMBER
gen008 (Rev. 8/21)
G:\Communications_Only\200 Products\206\General\gen008.indd
Refund Election
FOR OFFICE USE ONLY
(PERS Tier I/II/III, TRS Tier I/II, JRS)
ALASKA DIVISION OF
Retirement
Benefits
and
Division of Retirement and Benefits
Juneau: (907) 465-4460
Toll-Free: (800) 821-2251
P.O. Box 110203
TDD: (907) 465-2805
alaska.gov/drb
Juneau, AK 99811-0203
Fax: (907) 465-3086
DRB USE ONLY
EMP ____________________ BAL ___________________ PMT ___________________ SE _____________________
DB PERS
SIGN ___________________ TERM __________________ MAR __________________ WAIVER ________________
DB TRS
JRS
CEXP ___________________ DB 101 _________________ QDRO / CSED FLAG ______________________________
(CHECK ONE)
Public Employees’ Retirement System
Teachers’ Retirement System
Judicial Retirement System
SECTIONS A, B, C (IF APPLICABLE), E, AND F MUST BE COMPLETED PRIOR TO PROCESSING. IF NOT, THIS FORM WILL BE RETURNED TO
THE PARTICIPANT. THIS FORM SUPERSEDES ALL OTHER REVISIONS.
SECTION A. MEMBER INFORMATION
NAME (FIRST / M.I. / LAST)
LAST 4 OF SSN OR RETIREMENT IDENTIFICATION NUMBER (RIN)
BIRTH DATE (MM / DD / YYYY)
SEX
MARITAL STATUS
DATE OF MARRIAGE (MM / DD / YYYY)
Male
Female
Married
Divorced
Single
Widowed
PERSONAL TELEPHONE NUMBER
PERSONAL EMAIL ADDRESS
DATE OF DIVORCE (MM / DD / YYYY)
MAILING ADDRESS (STREET OR P.O. BOX)
CITY
STATE
ZIP+4
We will use this to confirm we have your correct address on file. If your address is different than what we have on file, we will not use this address to update
your account and your withdrawal may be delayed. If you believe we do not have your correct address or if you need to change your address, call us at
(907) 465-4460 before submitting this form.
SECTION B. FORM OF PAYMENT REQUESTED
(Total amount withdrawn and/or direct transfer/rollover must equal 100% of account balance.)
I elect the following lump sum payment:
Payment to Participant: Percent: ________% or Dollar Amount: $____________ (20% mandatory tax will be automatically withheld)
(If you would like additional federal income tax withheld, enter additional percent at right ________%)
Direct Transfer/Rollover: Percent: ________% or Dollar Amount: $____________
For a DIRECT TRANSFER/ROLLOVER, please complete the following OR indicate “See Attached” and attach the form from a financial institution
or a new qualified plan which contains the information requested below. Attach that form with your original signature appearing on the form.
FINANCIAL INSTITUTION / PLAN NAME
ACCOUNT NUMBER (MANDATORY)
PLAN ADDRESS
CITY
STATE
ZIP+4
CONTACT PERSON
TELEPHONE NUMBER
gen008 (Rev. 8/21)
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SECTION C. SPOUSE WAIVER
. NOT FOR USE BY EX-SPOUSE
(on account balances $5,000 or greater)
(See Section D)
Apostille may be required to authenticate a foreign notary. Please contact the Division for more information prior to submitting the Refund Election form.
(NAME OF SPOUSE
I,__________________
___________________, agree to the election of the “Form of Payment requested” made in Section B.
SPOUSE SIGNATURE
DATE (MM / DD / YYYY)
An original, handwritten signature is required on this form. Electronic signatures will not be accepted.
SPOUSE SIGNATURE WITNESSED BY A NOTARY:
Statement of notary:
STATE OF
(DAY)
The consent to this request was subscribed and sworn (or affirmed) to before me on this __
__ day of
(MONTH)
(YEAR)
(NAME OF SPOUSE)
______
______ year __
__, by ______________
_____________ proved to me on
COUNTY / PARISH / BOROUGH OF
the basis of satisfactory evidence to be the person who appeared before me who affirmed that such consent
represents their free and voluntary act.
NOTARY PUBLIC’S SIGNATURE
COMMISSION EXPIRES (MM / DD / YYYY)
SEAL OR
POSTMASTER STAMP
NOTARY PUBLIC’S FULL NAME
TELEPHONE NUMBER
REQUIRED
An original, handwritten signature is required on this form. Electronic signatures will not be accepted.
Notary seal must be visible.
OR
SPOUSE SIGNATURE WITNESSED BY ONE OF THE FOLLOWING:
Signature witnessed by one of the following: Retirement and Benefits Representative or Postmaster (must include postmaster stamp)
WITNESS SIGNATURE
DATE (MM / DD / YYYY)
TITLE
An original, handwritten signature is required on this form. Electronic signatures will not be accepted.
SECTION D. EX-SPOUSE REQUIRED DOCUMENTATION
If you were married for any length of time while contributing to the Public Employees’ Retirement System (PERS), Teachers’ Retirement System (TRS), or
Judicial Retirement System (JRS) and are now divorced or remarried, please send a court-certified copy of your divorce/ dissolution decree and the
property settlement or documents stating division of property/funds along with this Refund Election form. We will not process your refund request if we
do not have the appropriate ex-spousal documentation.
SECTION E. REINSTATEMENT OF SERVICE / SB 141
(PERS and TRS only. Participant must initial.)
With this election, I fully understand that, if I refund my employee contributions, Senate Bill 141 prohibits me from reinstating this service, which forfeits my
benefit rights under my current PERS / TRS tier.
(Handwritten initials required)
_________ YOU MUST INITIAL HERE
SECTION F. PAYMENT AUTHORIZATION APPROVAL
The Internal Revenue Service requires that you be given 30 days to review the options described in Section B. You may waive this right by checking the
box below. If you do not waive this 30-day review, PERS / TRS / JRS must delay processing your payment for an additional 30 days.
I WAIVE MY RIGHT OF THE 30-DAY REVIEW PERIOD FOR A DIRECT TRANSFER/ROLLOVER, OR PAYMENT TO PARTICIPANT.
(See General Information.)
I have read all of the instructions and the Special Tax Notice Regarding Plan Payments attached to this form. I understand that I forfeit my eligibility for
benefits and my tier rights if I refund my employee contributions. I further understand that, in order to be valid, elections must conform to the Plan
requirements. I understand that it is my duty to inform you of any Qualified Domestic Relations Order, Child Support Enforcement Order, or Internal
Revenue Service Order that entitles another person to a portion of my account or benefits. I also understand that I must make all changes to my election
prior to the payment date, and I cannot make changes after that date. I hereby certify that the information that I have supplied is true and correct and that
making a false or fraudulent statement(s) for the purpose of obtaining benefit is a criminal and civil offense punishable by law.
In completing this form, I acknowledge that a person who knowingly makes a false statement, or falsifies or permits to be falsified, a record of the retirement
system in an attempt to defraud the system, is guilty of a class A misdemeanor, which, upon conviction, is punishable by a fine of not more than $500.00
or by imprisonment for not more than twelve months or both (AS 39.35.670; AS 11.56.210; AS 14.25.530). I also acknowledge that a person who obtains
funds and/or benefits by deception may be subject to prosecution for other crimes, including theft, which may be charged as misdemeanors or felonies with
potential fines and penalties including imprisonment. I also acknowledge that a person who obtains funds and/or benefits from the system unlawfully may
also be required to make restitution.
PARTICIPANT SIGNATURE
DATE (MM / DD / YYYY)
An original, handwritten signature is required on this form. Electronic signatures will not be accepted.
gen008 (Rev. 8/21)
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REFUND ELECTION FORM INSTRUCTIONS
GENERAL INFORMATION
Eligibility
You will first be eligible for payment after you have been terminated from employment for 60 days. To receive payment, you must submit a current
completed Refund Election form.
Service
Refunded service cannot be used to satisfy vesting, retirement, or disability eligibility requirements. Refunding your employee contributions means you
forfeit your entitlement to benefits.
Rollovers/Transfer
Direct rollovers/transfer will be allowed only if the rollover eligible amount is over $200.
EX-SPOUSE’S OR QUALIFIED DOMESTIC RELATIONS ORDER (QDRO)
If you were married during your employment and the divorce or dissolution document indicates that you are solely entitled to the entire account balance,
you must supply us a court-certified copy of the divorce decree and the property settlement that has been approved by the court that indicates you are
entitled to the entire account.
If a Qualified Domestic Relations Order (QDRO) exists that already allocates a portion of your account to an alternate payee or ex-spouse, you must
supply a court-certified copy of that order.
INCOME TAX AND PENALTY INFORMATION
The State of Alaska and the Division of Retirement and Benefits do not give tax advice.
You are solely responsible to determine how federal
tax law affects your particular situation.
You should contact the Internal Revenue Service or your tax advisor as necessary.
402(F) Notice of Special Tax Rules on Distributions
Your Rollover Options
You are receiving this notice because all or a portion of a payment you are receiving from a State of Alaska Defined Benefit Plan (the “Plan”) is eligible to
be rolled over to an IRA or an employer plan. This notice is intended to help you decide whether to do such a rollover.
This notice describes the rollover rules that apply to payments from the Plan that are not from a designated Roth account (a type of account in some
employer plans that are subject to special tax). If you also receive a payment from a designated Roth account in the Plan, you will be provided a different
notice for that payment, and the Plan administrator or the payor will tell you the amount that is being paid from each account.
Rules that apply to most payments from a plan are described in the “General Information About Rollovers” section. Special rules that only apply in
certain circumstances are described in the “Special Rules and Options” section.
General Information About Rollovers
How can a rollover affect my taxes?
You will be taxed on a payment from the Plan if you do not roll it over. If you are under age 59-1/2 and do not do a rollover, you will also have to pay a
10% additional income tax on early distributions (generally, distributions made before age 59-1/2), unless an exception applies. However, if you do a
rollover, you will not have to pay tax until you receive payments later and the 10% additional income tax will not apply if those payments are made after
you are age 59-1/2 (or if an exception to the 10% additional income tax applies).
What types of retirement accounts and plans may accept my rollover?
You may roll over the payment to either an IRA (an individual retirement account or individual retirement annuity) or an employer plan (a tax-qualified
plan, section 403(b) plan, or governmental section 457(b) plan) that will accept the rollover. The rules of the IRA or employer plan that holds the rollover
will determine your investment options, fees, and rights to payment from the IRA or employer plan (for example, IRAs are not subject to spousal consent
rules, and IRAs may not provide loans). Further, the amount rolled over will become subject to the tax rules that apply to the IRA or employer plan.
How do I do a rollover?
There are two ways to do a rollover. You can do either a direct rollover or a 60-day rollover.
If you do a direct rollover, the Plan will make the payment directly to your IRA or an employer plan. You should contact the IRA sponsor or the
administrator of the employer plan for information on how to do a direct rollover.
If you do not do a direct rollover, you may still do a rollover by making a deposit into an IRA or eligible employer plan that will accept it. Generally, you
will have 60 days after you receive the payment to make the deposit. If you do not do a direct rollover, the Plan is required to withhold 20% of the
payment for federal income taxes (up to the amount of cash and property received other than employer stock). This means that, in order to roll over the
entire payment in a 60-day rollover, you must use other funds to make up for the 20% withheld. If you do not roll over the entire amount of the payment,
the portion not rolled over will be taxed and will be subject to the 10% additional income tax on early distributions if you are under age 59-1/2 (unless an
exception applies).
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REFUND ELECTION FORM INSTRUCTIONS
How much may I roll over?
If you wish to do a rollover, you may roll over all or part of the amount eligible for rollover. Any payment from the Plan is eligible for rollover, except:
• Certain payments spread over a period of at least 10 years or over your life or life expectancy (or the lives or joint life expectancy of you and your
beneficiary);
• Required minimum distributions after age 70-1/2 (if you were born before July 1, 1949) or age 72 (if you were born after June 30,
• 1949) or after death;
• Hardship distributions;
• Payments of employee stock ownership plan (ESOP) dividends;
• Corrective distributions of contributions that exceed tax law limitations;
• Loans treated as deemed distributions (for example, loans in default due to missed payments before your employment ends);
• Cost of life insurance paid by the Plan;
• Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of the first contribution;
• Amounts treated as distributed because of a prohibited allocation of S corporation stock under an ESOP (also, there will generally be adverse tax
consequences if you roll over a distribution of S corporation stock to an IRA); and
• Distributions of certain premiums for health and accident insurance.
The Plan administrator or the payor can tell you what portion of a payment is eligible for rollover.
If I don’t do a rollover, will I have to pay the 10% additional income tax on early distributions?
If you are under age 59-1/2, you will have to pay the 10% additional income tax on early distributions for any payment from the Plan (including amounts
withheld for income tax) that you do not roll over, unless one of the exceptions listed below applies. This tax applies to the part of the distribution that you
must include in income and is in addition to the regular income tax on the payment not rolled over.
The 10% additional income tax does not apply to the following payments from the Plan:
• Payments made after you separate from service if you will be at least age 55 in the year of the separation;
• Payments that start after you separate from service if paid at least annually in equal or close to equal amounts over your life or life expectancy (or
the lives or joint life expectancy of you and your beneficiary);
• Payments from a governmental plan made after you separate from service if you are a qualified public safety employee and you will be at least age
50 in the year of the separation;
• Payments of up to $5,000 made to you from a defined contribution plan if the payment is a qualified birth or adoption distribution;
• Payments made due to disability;
• Payments after your death;
• Payments of ESOP dividends;
• Corrective distributions of contributions that exceed tax law limitations;
• Cost of life insurance paid by the Plan;
• Payments made directly to the government to satisfy a federal tax levy;
• Payments made under a qualified domestic relations order (QDRO);
• Payments up to the amount of your deductible medical expenses (without regard to whether you itemize deductions for the taxable year);
• Certain payments made while you are on active duty if you were a member of a reserve component called to duty after
• September 11, 2001, for more than 179 days;
• Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of the first contribution;
• Payments excepted from the additional income tax by federal legislation relating to certain emergencies and disasters; and
• Phased retirement payment made to federal employees.
If I do a rollover to an IRA, will the 10% additional income tax apply to early distributions from the IRA? If you receive a payment from an IRA when you
are under age 59-1/2, you will have to pay the 10% additional income tax on early distributions on the part of the distribution that you must include in
income, unless an exception applies. In general, the exceptions to the 10% additional income tax for early distributions from an IRA are the same as the
exceptions listed above for early distributions from a plan. However, there are a few differences for payments from an IRA, including:
• The exception for payments made after you separate from service if you will be at least age 55 in the year of the separation
• (or age 50 for qualified public safety employees) does not apply;
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REFUND ELECTION FORM INSTRUCTIONS
• The exception for qualified domestic relations orders (QDROs) does not apply (although a special rule applies under which, as part of a divorce or
separation agreement, a tax-free transfer may be made directly to an IRA of a spouse or former spouse); and
• The exception for payments made at least annually in equal or close to equal amounts over a specified period applies without regard to whether you
have had a separation from service.
• Additional exceptions apply for payments from an IRA, including:
• Payments for qualified higher education expenses;
• Payments up to $10,000 used in a qualified first-time home purchase; and
• Payments for health insurance premiums after you have received unemployment compensation for 12 consecutive weeks (or would have been
eligible to receive unemployment compensation but for self-employed status).
Will I owe State income taxes?
This notice does not describe any State or local income tax rules (including withholding rules).
Special Rules and Options
If Your Payment Includes After-Tax Contributions
After-tax contributions included in a payment are not taxed. If a payment is only part of your benefit, an allocable portion of your aftertax contributions is
included in the payment, so you cannot take a payment of only after-tax contributions. However, if you have pre-1987 after-tax contributions maintained
in a separate account, a special rule may apply to determine whether the after-tax contributions are included in a payment. In addition, special rules
apply when you do a rollover, as described below.
You may roll over to an IRA a payment that includes after-tax contributions through either a direct rollover or a 60-day rollover. You must keep track of
the aggregate amount of the after-tax contributions in all of your IRAs (in order to determine your taxable income for later payments from the IRAs).
If you do a direct rollover of only a portion of the amount paid from the Plan and at the same time the rest is paid to you, the portion directly rolled over
consists first of the amount that would be taxable if not rolled over. For example, assume you are receiving a distribution of $12,000, of which $2,000 is
after-tax contributions. In this case, if you directly roll over $10,000 to an IRA that is not a Roth IRA, no amount is taxable because the $2,000 amount
not rolled over is treated as being after-tax contributions. If you do a direct rollover of the entire amount paid from the Plan to two or more destinations at
the same time, you can choose which destination receives the aftertax contributions.
Similarly, if you do a 60-day rollover to an IRA of only a portion of a payment made to you, the portion rolled over consists first of the amount that would
be taxable if not rolled over. For example, assume you are receiving a distribution of $12,000, of which $2,000 is after-tax contributions, and no part of
the distribution is directly rolled over. In this case, if you roll over $10,000 to an IRA that is not a Roth IRA in a 60-day rollover, no amount is taxable
because the $2,000 amount not rolled over is treated as being after-tax contributions.
You may roll over to an employer plan all of a payment that includes after-tax contributions, but only through a direct rollover (and only if the receiving
plan separately accounts for after-tax contributions and is not a governmental section 457(b) plan). You can do a 60-day rollover to an employer plan of
part of a payment that includes aftertax contributions, but only up to the amount of the payment that would be taxable if not rolled over.
If You Miss the 60-Day Rollover Deadline
Generally, the 60-day rollover deadline cannot be extended. However, the IRS has the limited authority to waive the deadline under certain extraordinary
circumstances, such as when external events prevented you from completing the rollover by the 60-day rollover deadline. Under certain circumstances,
you may claim eligibility for a waiver of the 60-day rollover deadline by making a written self-certification. Otherwise, to apply for a waiver from the IRS,
you must file a private letter ruling request with the IRS. Private letter ruling requests require the payment of a nonrefundable user fee. For more
information, see IRS Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs).
If Your Payment Includes Employer Stock That You Do Not Roll Over
If you do not do a rollover, you can apply a special rule to payments of employer stock (or other employer securities) that are either attributable to
after-tax contributions or paid in a lump sum after separation from service (or after age 59-1/2, disability, or the participant’s death). Under the special
rule, the net unrealized appreciation on the stock will not be taxed when distributed from the Plan and will be taxed at capital gain rates when you sell the
stock. Net unrealized appreciation is generally the increase in the value of employer stock after it was acquired by the Plan. If you do a rollover for a
payment that includes employer stock (for example, by selling the stock and rolling over the proceeds within 60 days of the payment), the special rule
relating to the distributed employer stock will not apply to any subsequent payments from the IRA or, generally, the Plan. The Plan administrator can tell
you the amount of any net unrealized appreciation.
If You Have an Outstanding Loan That is Being Offset
If you have an outstanding loan from the Plan, your Plan benefit may be offset by the outstanding amount of the loan, typically when your employment
ends. The offset amount is treated as a distribution to you at the time of the offset. Generally, you may roll over all or any portion of the offset amount.
Any offset amount that is not rolled over will be taxed (including the 10% additional income tax on early distributions, unless an exception applies). You
may roll over offset amounts to an IRA or an employer plan (if the terms of the employer plan permit the plan to receive plan loan offset rollovers).
How long you have to complete the rollover depends on what kind of plan loan offset you have. If you have a qualified plan loan offset, you will have until
your tax return due date (including extensions) for the tax year during which the offset occurs to complete your rollover. A qualified plan loan offset
occurs when a plan loan in good standing is offset because your employer plan terminates, or because you sever from employment. If your plan loan
offset occurs for any other reason (such as a failure to make level loan repayments that results in a deemed distribution), then you have 60 days from
the date the offset occurs to complete your rollover.
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