Alaska Form Gen020 PDF Details

Who must file the GEN020 form?

The Alaska GEN020 form must be filed annually by retirees enrolled in the Alaska Division of Retirement and Benefits who receive Cost-of-Living Allowance payments. This affidavit confirms your continued Alaska residency and intent to maintain domicile in the state. If you receive COLA benefits and have not filed your annual affidavit, your payments may be suspended pending verification.

What information does the GEN020 require?

To complete the GEN020, you need your full name, the last four digits of your Social Security Number, and both your physical and mailing addresses in Alaska. You must also provide the name of an unrelated adult Alaska resident who can certify your residency. The completed form must be witnessed by a Division of Retirement and Benefits representative, a Division of Personnel Staff member, or a notary public. See the Alaska Form 02-1890 for related state benefit documentation.

How does Alaska define COLA residency?

Alaska defines residency for COLA purposes as maintaining a principal place of residence within the state, demonstrating intent to return during any absence, and making no residency claims or benefit applications in other states. The Division requires customary ties to Alaska such as a permanent home address, voter registration, and vehicle registration as evidence of your intent to remain in the state.

What are the penalties for false information?

Submitting false information on the GEN020 can result in a Class A Misdemeanor charge under Alaska law. Fraudulent affidavits may also require repayment of incorrectly received COLA benefits and result in permanent loss of eligibility. The Division investigates residency claims thoroughly, so ensure all information is accurate and current before signing.

QuestionAnswer
Form NameAlaska Form Gen020
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesgen020 alaska affidavit of residency form

Form Preview Example

Alaska Cost-of-Living Allowance (COLA)

Afidavit of Residency

 

ＩＲＵ＃ＲＩＩＬＦＨ＃ＸＶＨ＃ＲＱＯ＼＃

 

 

 

 

 

 

Division of Retirement and Beneits

Juneau: 465-4460

Toll-Free: 1-800-821-2251

PO Box 110203

TDD: (907) 465-2805

alaska.gov/drb

Juneau, Alaska 99811-0203

Fax: (907) 465-3086

Name (First, M.I., Maiden, Last)

Social Security Number (last 4 digits)

Physical Address (Street Address, City, State)

Mailing Address (City, State, ZIP+4)

COLA is for retirees who reside in the State of Alaska. Resides means domiciled and physically present in the state.

2 AAC 36.210 (TRS) and 2 AAC 35.240 (PERS) states a person domiciled in the state is a person who:

(1)maintains his or her principal place of residence in the State of Alaska;

(2)demonstrates at all times during an absence an intent to return to Alaska and remain a resident of Alaska;

(3)does not claim residency outside the state or obtain beneits or residency in another state or nation.

The administrator’s determination of an applicant’s residency will be based on the totality of relevant circumstances. Intent is demon- strated by establishing and maintaining customary ties indicative of Alaska residency.

AS 39.35.670 (PERS) and AS 14.25.210 (TRS) — A person who knowingly makes a false statement, or falsiies or permits to be falsiied a record of this system, in a attempt to defraud the system, is guilty of a Class A Misdemeanor and upon conviction is punishable by a ine of not more than $500 or by imprisonment for not more than 12 months, or by both.

This form must be certiied by an adult Alaska resident not related to the applicant who can verify the applicant’s Alaska residency.

CERTIFICATION: I certify the above applicant is a resident of Alaska and intends to remain a resident of Alaska. I further certify the applicant resides in the above physical address which is his/her true, ixed permanent home and principal residence. I have irst hand knowledge the applicant’s household goods are maintained in this residence and it is inhabited primarily by the applicant.

Print name of person certifying this form

Telephone Number

Mailing Address

Signature of certiier, witnessed by one of the following: DRB Representative or Division of Personnel Staff

Signature

__________________________________ Title ____________________________ Date

/

/______

 

OR, SIGNATURE WITNESSED BY A NOTARY

 

 

 

 

On this

 

 

day of

 

20 ,

 

personally appeared before me whose identity

 

 

 

 

 

 

 

 

 

 

 

 

 

I proved on the basis of satisfactory evidence to be the signer of the participant's signature above, and he/she acknowledged that he/she executed it.

 

Notary Public ____________________________________________________________

NOTARY SEAL OR

State of _________________________

and Borough/County of __________________

POSTMASTER

 

 

STAMP

Residing at ______________________

Commission Expires ____________________

REQURIED

 

 

GEN020 (Rev. 3/11)

g:/publications/forms/general/gen020.indd

How to Edit Alaska Form Gen020 Online for Free

Steps to fill out the Alaska GEN020 online

Use the FormsPal PDF editor to complete your Alaska GEN020 form directly in your browser. No software installation is required. Follow these steps to finish the affidavit:

  1. Open the form: Click "Get Form" at the top of this page to launch the PDF editor with your Alaska GEN020 loaded.
  2. Enter your personal details: Fill in your full name, the last four digits of your Social Security Number, and your current physical and mailing addresses in Alaska.
  3. Add witness information: Enter the name and contact details of an unrelated adult Alaska resident who can certify your residency. This person cannot be a relative.
  4. Arrange notarization: Have a Division of Retirement and Benefits representative, a Division of Personnel Staff member, or a notary public witness your signature on the affidavit.
  5. Download or email: Save the completed form to your device or send it directly from FormsPal to the Division of Retirement and Benefits.
How you can fill in Alaska Form Gen020 part 1

Common mistakes to avoid when filing the GEN020

Many retirees make errors in the witness certification section. Your chosen witness must be an unrelated adult who currently lives in Alaska. A relative or non-resident cannot sign as your witness. Also verify that your physical Alaska address matches your state records, as discrepancies can delay processing or trigger a residency review by the Division.

For other Alaska state documents, explore the Alaska Employer Registration Form, the Alaska Living Will Form, or the Financial Affidavit templates on FormsPal.

Alaska Form Gen020 isn’t the one you’re looking for?

Related Documents