Lacera Rsd 562 Form PDF Details

Do you need to fill out the Lacera Rsd 562 form? This important form is used in California by employers and workers who pay into the Retirement System Plan No. 2 (R2). Completing this paperwork can be daunting, but it doesn't have to be! In this blog post, we'll guide you through all of the necessary steps needed to complete this tax document correctly and submit it on time. Whether you're an employer or employee filing a new R2 claim or an existing one, read on for helpful tips and detailed instructions on how to get started.

QuestionAnswer
Form NameLacera Rsd 562 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameslacera withdrawal form, apply for lacera retirement, lacera business, lacera

Form Preview Example

Los Angeles County Em ployees Retirem ent Association

300 N . Lake Ave., Pasadena, CA 91101 M ail to: PO Box 7060, Pasadena, CA 91109-7060

626/ 564-6132 • 800/ 786-6464

WITHDRAWAL APPLICATION

A

Please type or print legibly.

 

SECTION I – TERMINATION OF COUNTY SERVICE

 

 

 

On ______________, I terminated service with the following department: ___________________________________________,

Date

and I am no longer employed by Los Angeles County.

Print Name _____________________________________________________________________________________________________

FirstMiddleLast

Home Address __________________________________________________________________________________________________

 

Street

City

State

ZIP

Social Security # _________ - ______ - ___________ Employee # _____________________

Department # ________________

Work Phone (

) _____________________________

Home Phone (

) ___________________________________

SECTION II – WITHDRAWAL (with or without a rollover)

You may request your contributions be paid directly to you. Or, you may request that the taxable portion of your contribu- tions, plus interest, be rolled over to an IRA or another employer's qualified plan. If your contributions are paid directly to you, or if you roll over less than 100% of the taxable portion of your contributions, LACERA must deduct 20% for manda- tory federal income tax withholding; the balance will be refunded to you. If the entire taxable portion is not rolled over into an IRA or other employer's qualified plan within 60 days after you receive it, you may owe tax penalties in addition to the 20% withheld. You may request that LACERA withhold state tax by indicating a percentage or specified amount below; or you may pay directly to the State Franchise Tax Board when you file your income taxes for the year. Nontaxable contribu- tions, if any, will be refunded to you.

Check the box es that apply to you, then read and complete Section III.

1.

2.

I request to withdraw my contributions, plus interest, and have them paid directly to me. I also request LACERA

withhold state tax at:

2% or

_____% or

$________________ specified amount

None

I request to roll over

100% or

_____% of the taxable portion of my contributions, plus interest, to:

3.

Name of IRA Institution

 

 

IRA Account Number (not Social Security number)

 

 

 

 

 

 

Address of IRA Institution

 

City

State

ZIP

I request to roll over

100% or

_____% of the taxable portion of my contributions, plus interest, to the

following employer’s qualified plan:

Name of Plan

Name of Employer

Address of Employer

City

State

ZIP

 

 

 

 

Name of Trustee

 

 

 

 

 

 

 

Address of Trustee

City

State

ZIP

 

 

 

 

Plan/ Trust EIN (Employer Identification Number)

 

 

 

(OVER)

RSD 562 (9/ 00)

SECTION III – AUTHORIZATION

I have read and understand all materials included with this form. I understand that:

IF I CHOOSE A WITHDRAWAL, I LOSE ALL RIGHTS TO FUTURE RETIREMENT BENEFITS FROM LACERA, INCLUDING DISABILITY BENEFITS.

If I have requested that the taxable portion of my contributions, plus interest, be rolled over into an IRA or another employer’s qualified plan, I will receive a check made payable to the institution named in Section II. It is my responsibil- ity to deposit it with the appropriate institution. I understand that LACERA will not verify that the information provid- ed is correct. It is my responsibility to provide accurate information and to verify that the IRA institution or other employer’s plan is qualified to accept a rollover.

If I choose to have a withdrawal paid directly to me, or roll over less than 100% of the taxable portion of my contribu- tions plus interest, LACERA will withhold 20% of the taxable portion for federal income taxes.

If you are requesting a w ithdraw al paid directly to you, or a rollover, you must sign this form in the presence of an authorized LACERA representative or a N otary Public.

_____________________________________________________________________________________________

Your SignatureD ate

____________________________________________________________________________________________________________________

Authorized LACERA Representative

D ate

THIS FORM MUST BE NOTARIZED BEFORE RETURNING TO LACERA

State of _____________________________________________________

County of ___________________________________________________

On _____________________, before me the undersigned, a Notary Public, personally appeared.

Month/ Day/ Year

Name(s) of Signer(s)_______________________________________________________________________________________,

personally known to me - OR - proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/ are subscribed to the within instrument and acknowledged to me that he/ she/ they executed the same in his/ her/ their authorized capacity(ies), and that by his/ her/ their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

My commission expires _____________________

Date

 

WITN ESS my hand and official seal.

S.S.

Signature of Notary Public