In order to ensure your business's compliance with state and federal laws, it is important to understand the different types of tax forms your company may be required to file. Form Et 0868 0812 is one such form, used for reporting payment of withholding taxes. This article will provide a brief overview of the form and its usage. For more detailed information, please consult your tax advisor or state revenue agency. Thank you for your interest in this topic!
| Question | Answer |
|---|---|
| Form Name | Form Et 0868 0812 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | et0868 tpaf tier to tier transfer form |
NEW JERSEY DIVISION OF PENSIONS AND BENEFITS
See reverse side for instructions on completing this form.
PO BOX 295
TRENTON, NJ
|
|
INDICATE RETIREMENT SYSTEM: |
|
|
|
Public Employees’ Retirement System (PERS) |
Teachers’ Pension and Annuity System (TPAF) |
||
|
Police and Firemen’s Retirement System (PFRS) |
|
|
|
|
|
|
||
THIS SECTION TO BE COMPLETED BY THE MEMBER: |
|
|
||
1. |
Social Security Number:__________________________ 2. Pension Membership Number: _____________________ |
|||
3. |
Name:________________________________________________________________________________________ |
|||
|
Last |
First |
Middle |
Maiden |
4. |
Address:______________________________________________________________________________________ |
|||
|
|
Street |
|
|
|
_________________________________________________________________________________________ |
|||
|
City |
State |
|
Zip Code |
5. |
Daytime Telephone: ___________________________________ |
|
|
|
|
Area Code |
Number |
|
|
|
|
|
|
|
INACTIVE MEMBERSHIP: |
|
|
|
|
6. |
Inactive Pension Membership Number:______________________________________ |
|
||
7. I Certify that I:
Resigned
Was dismissed with no appeal pending Was dismissed with appeal pending Was laid off
CHECK ONE
from my position as _____________________________________________________________
Title of Position
8. Date of Termination: _____/_____/_____ 9. Membership Tier of inactive membership:_____________________
Month Day Year |
|
|
|
ACTIVE MEMBERSHIP: |
|
10. New Employer:________________________________________________________ |
_______________________ |
New Employer Name |
County |
11. Membership Tier under current (active) membership:_________________________
I hereby apply for the transfer of my inactive membership to the active Membership Tier indicated above and authorize payment of the withdrawal value of my account be made to that new Membership Tier subject to the statutes, rules, and regulations of the retirement system. The transfer shall include all eligible pension service credit and corresponding pension contributions.
•I understand that once my
•I understand that prior to submitting this form, I have the right to request a retirement estimate based on my inactive pension membership.
•By signing the
Signature of Applicant___________________________________________________ Date _____________________
INSTRUCTIONS
The
Notes on Question #7 regarding your inactive membership account:
•If you were dismissed from your position and are in the process of appealing that dismissal, you cannot complete the transfer until a decision has been rendered or your appeal is withdrawn.
•If your position was abolished due to a layoff or a reduction in force, your employer must notify the Division of Pensions and Benefits in writing, and your membership in the fund can remain inactive for a maximum of ten years (five years for PFRS members).
•Your membership will not end two years after your last contribution if you are granted an official leave of absence (the
•Extensions are not automatic. You must provide the Division of Pensions and Benefits with sup- porting documentation from your employer that evidences layoff, the abolishment of your position, or extension of a leave of absence.
For additional information regarding “Membership Tiers” (Questions #9 and #11), please see the Division’s Web site.
•TPAF and PERS members visit:
•PFRS members visit: www.state.nj.us/treasury/pensions/epbam/exhibits/handbook/pfrsbook.pdf
If your membership has been withdrawn, you cannot transfer any service credit from the old member- ship; you may, however, be eligible to purchase the prior pension service credit rendered under the for- mer membership (see Fact Sheet #1, Purchasing Service Credit (PERS, TPAF & PFRS) available on the Division’s Web site at:
Please forward this completed form to:
Enrollment Section
Division of Pensions and Benefits
PO Box 295
Trenton, NJ
THE MEMBER SHOULD ENSURE THAT ALL ITEMS ARE COMPLETE
PRIOR TO SUBMISSION OF THIS FORM.
IF ANY ITEMS ON THIS FORM ARE INCOMPLETE OR LEFT BLANK
PROCESSING WILL BE DELAYED.