Please rate Co 1049A Form 12-2019
This form is intended for use with SERS only. Every LDPOA is subject to review and approval by the Retirement Services Division (RSD).
Witnessed and notarized: this two page document must be signed, dated, witnessed and notarized where indicated.
Original: keep a copy for your records and send the original LDPOA (both pages) directly to the Retirement Services Division, Payroll Unit.
Limited use: this LDPOA is limited to certain post retirement transactions such as changing an address or tax withholding.
After retirement: payment election options and survivor (contingent) annuitants cannot be changed for any reason after retirement.
| Question | Answer |
|---|---|
| Form Name | Form CO-1049A |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 28 |
| Avg. time to fill out | 5 min |
| Edition | Rev 12/2019 |
| Issuing agency | State of Connecticut Office of the State Comptroller Retirement Services Division |
| Where to send | Retirement Services Division, Payroll Unit, 165 Capitol Avenue, Hartford, CT 06106 |
| Other names | CO-1049A, CO1049A, Form CO-1049A, LDPOA, Limited Durable Power of Attorney Post Retirement |
| Official source | Form CO-1049A (Rev 12/2019), State of Connecticut Office of the State Comptroller Retirement Services Division |
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Please rate Co 1049A Form 12-2019
