Form Rs5042 PDF Details

Exploring the intricacies of the RS5042 form unveils a critical process for individuals within the New York State and Local Retirement System, specifically targeting members from the Employees’ Retirement System and the Police and Fire Retirement System. Housed under the vigilant eyes of the Office of the New York State Comptroller and finding its home on 110 State Street in Albany, New York, this form serves a pivotal role. It is ingeniously crafted to aid in the request for recognition of previously unacknowledged service periods, which in turn, may significantly influence an individual's retirement benefits. This extends to encompass prior military service, a gesture acknowledging the sacrifice and dedication of our veterans. With sections meticulously tailored to capture essential details such as registration number, social security number, and the span of service both in terms of length and capacity, the form is a comprehensive tool. It seeks information not just about the individual’s current employment status within various levels of public service—be it state, county, city, town, or otherwise—but also about historical employment details that might have been overlooked. This endeavor to ensure that every day of service counts towards retirement speaks volumes about the commitment of the state to honor its workforce, making the RS5042 form a linchpin in the architecture of retirement benefits.

QuestionAnswer
Form NameForm Rs5042
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesrs 5042, e-State, how to submit form rs 5042, New_York

Form Preview Example

New York State and Local Retirement System

 

 

Request for Previous Service

Ofice of the New York State Comptroller

 

 

 

 

 

 

 

 

 

 

 

 

 

Employees’ Retirement System

 

 

 

 

 

 

 

 

 

 

RS 5042

Police and Fire Retirement System

 

 

 

 

 

 

 

 

 

 

110 State Street, Albany, New York 12244-0001

 

 

 

 

 

 

 

 

 

(Rev. 6/11)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Previous Name

 

 

 

 

 

Name _____________________________________

D.O.B. _________________ Registration Number ______________________

S.S. Number ________________________

You May Have Been Using______________________

(Print or Type)

 

 

 

 

 

 

 

 

 

 

 

 

 

By Whom Currently Employed____________________________________________________________________________________

Department Where Now Employed____________________________________________________

 

(Indicate whether State, County, City, Town, Village, Special District, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RECORD OF ADDITIONAL SERVICE NOT INCLUDED IN FORMER STATEMENT OF SERVICES INCLUDING MILITARY SERVICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Public employer you

Name of Department

 

 

Registration Number

 

 

FROM

 

TO

 

LENGTH OF SERVICE

worked for during previous

 

Name of Retirement System

 

 

 

 

or Agency for

 

(During previous

Title of Position(s)

 

 

 

 

 

 

 

 

 

services claimed (i.e-State,

 

(If you were a member)

 

 

 

 

 

 

 

 

 

that employer

 

membership-if known)

 

Mo.

Day

Year

Mo.

Day

Year

Mo.

Day

Year

County, Town, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This form is to request additional retirement service credit

 

 

 

ADDITIONAL TOTAL SERVICE CLAIMED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Home Address ___________________________________________________________________________

Telephone Number _______________________________________________________

 

No.

Street

 

 

 

 

 

 

 

 

 

 

 

______________________________________________________________________________________________

Signed ________________________________________________________________

City

State

Zip Code

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This form will require specific information; in order to guarantee correctness, be sure to heed the suggestions just below:

1. The rs 5042 requires certain details to be inserted. Ensure that the following blanks are finalized:

Filling in segment 1 of nys retirement form rs5042

2. After the prior part is filled out, proceed to type in the suitable details in these: This form is to request additional, ADDITIONAL TOTAL SERVICE CLAIMED, Current Home Address, No Street, Telephone Number, City, State, Zip Code, and Signed.

State, Telephone Number, and ADDITIONAL TOTAL SERVICE CLAIMED inside nys retirement form rs5042

Be very careful while completing State and Telephone Number, because this is the part in which many people make mistakes.

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