Form Es 0350 is a tax form that must be completed in order to claim exemption from state and local taxation. This form can be used by individuals or businesses, and allows for certain exemptions from taxes that would otherwise be due. The specific exemptions that are available vary depending on the jurisdiction in question, so it is important to consult with a tax specialist to see if you are eligible for any of them. Completing Form Es 0350 can save taxpayers money, so it is worth taking the time to understand this document and determine if you qualify for any of its exemptions.
Question | Answer |
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Form Name | Form Es 0350 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | false, submits, pursuant, applicable |
PermissiveMembership
ES 0350 (Rev. 6/11)
PERMISSIVE ELECTION AND ACKNOWLEDGEMENT OF RECEIPT OF CALSTRS DEFINED BENEFIT PLAN MEMBERSHIP INFORMATION
California State Teachers’ Retirement System
P.O. Box 15275, MS 17
Sacramento, CA
CalSTRS.com
An employee who performs creditable service (Education Code Section 22119.5), and who is excluded from mandatory membership pursuant to Section 22601.5, 22602, or 22604, may elect membership in the California State Teachers’ Retirement System (CalSTRS) Defined Benefit Program at any time while employed to perform creditable service. If you elect membership below, then your election becomes irrevocable until you terminate employment. This form containing your election must be on file with CalSTRS before your employer submits contributions into the program.
EMPLOYEE CERTIFICATION
NAME (LAST, FIRST, INITIAL) |
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CLIENT ID OR SOCIAL SECURITY NUMBER |
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MAILING ADDRESS |
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POSITION TITLE |
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CITY |
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HOME TELEPHONE |
With my signature below, I certify that I have received information from my employer on my eligibility to elect membership in CalSTRS Defined Benefit Program and that I am making the following election. I fully understand this election is irrevocable and applies to all future creditable service until I terminate employment.
I understand it is a crime to fail to disclose a material fact or to make any knowingly false material statements for the purpose of altering a benefit administered by CalSTRS and it may result in penalties, including restitution, up to one year in jail and a fine of up to $5,000 (Education Code Section 22010).
I elect membership |
I decline membership at this time |
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SIGNATURE |
DATE |
TO BE COMPLETED BY EMPLOYER
With my signature below, I certify that the
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COUNTY (or Other Employing Agency) |
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EMPLOYEE #
SEX
MALE FEMALE
BIRTHDAY
(MO/DAY/YEAR)
MEMBERSHIP DATE
(MO/DAY/YEAR)
ASSIGNMENT
FT PT SUB
PERMISSIVE MEMBERSHIP • REV 06/11