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CERF Forms

Submit all completed forms to your County Clerk. Contact your County Clerk or the CERF Administrative Office if you have any questions about the pension plan forms.


Submit all completed forms to your County Clerk. Contact the Empower Retirement Office at 1-877-895-1394 if you have any questions about the savings plan forms.

Form Name Last Revision
Savings Plan Enrollment May 19
401(a) Beneficiary Jun 18
401(a) In Service Withdrawal Age 59.5 or Older Apr 19
401(a) Incoming Direct Rollover Apr 19
401(a) Separation From Employment Withdrawal Request Apr 19
401(a) Death Claim Apr 19
457 Beneficiary May 18
457 In Service Withdrawal Age 70.5 Apr 19
457 Incoming Transfer Apr 19
457 Paycheck Contribution Election Apr 19
457 Death Claim Apr 19
457 Separation From Employment Withdrawal Request Apr 19

Enrollment
Form Number Form Name Last Revision
1 Enrollment May 19
1A Beneficiary Designation - $10,000 Death Benefit/Non-Vested Refund of Contributions July 17
8 Beneficiary Designation - Unmarried Vested Death Benefit May 19
Term-Non Vested
2A Refunds - Payment Election July 19
Instructions Instructions for Form 2A - Refunds Payment Election March 19
Death
Form Number Form Name Last Revision
9 Application by Spouse November 15
3A Death Benefits - Non-Spouse Payment Election $10,000 Death Benefit April 19
3B Death Benefit - Spouse Payment Election $10,000 Death Benefit April 19
3C Death Benefit - Non-Designated Non-Spouse Payment Election $10,000 Death Benefit April 19
4A Death Benefits - Designated Non-Spouse Payment Election Single-Vested/Non-Vested Refund April 19
4B Death Benefit - Spouse Payment Election Non-Vested Refund April 19
4C Death Benefits - Non-Designated Non-Spouse Payment Election Single-Vested/Non-Vested Refund April 19
Instructions Instructions for Forms 3A, 3B, 3C, 4A, 4B & 4C - Death Benefits Payment Election April 19





Term Vested
Form Number Form Name Last Revision
2V Termination Vested Jun 18
2B Retirement Application
Designation of Survivor
(Employees termed after 12/31/1999)
June 17
6 Retirement Application
(Employees termed before 1/1/2000)
June 16
EFT Electronic Funds Transfer July 19
Fed-W4P Federal Withholding for Pension or Annuity Payments February 19
MO-W4P Missouri Withholding for Pension or Annuity Payments November 13
2C Co-Annuitant for 10 Year Certain March 09








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