Montana Form 1024 – Fill Out and Use This PDF

The Montana 1024 form is an essential document for volunteer firefighters in Montana looking to apply for pension benefits under the Volunteer Firefighters' Compensation Act (VFCA). This form enables eligible firefighters to receive pension benefits upon meeting specific service or age requirements and outlines the process for applying, including details on survivor benefits, direct deposit elections, and tax withholdings. For those ready to secure their future after serving as volunteer firefighters, click the button below to begin filling out your Montana 1024 form.

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Montana Form 1024 PDF Details

The Montana 1024 form represents a vital document for volunteer firefighters in Montana, serving as the gateway to accessing pension benefits under the Volunteer Firefighters' Compensation Act (VFCA). Crafted by the Montana Public Employee Retirement Administration, this comprehensive form not only facilitates the application process for pension benefits but also outlines the crucial terms and conditions tied to these benefits. Noteworthy is the form's inclusivity in allowing applicants who have either met the necessary service or age requirements to apply for their pension without the mandate of being an active member of a fire company. With eligibility for a full pension benefit set at a minimum of 20 years of credited VFCA service and the attainment of 55 years of age, retirees are assured of receiving a monthly base pension of $150, with incremental increases for each year of service beyond the 20-year mark up to 30 years, and potentially further based on the pension trust fund's status. Also, it provisions for a partial pension benefit for those with at least ten but less than 20 years of service upon reaching the age of 60. The form also necessitates the completion of sections regarding survivor information, direct deposit election, and tax withholding preferences, alongside the submission of requisite documents and witnessed signatures to ensure a smooth application process. By addressing these considerations, the Montana 1024 form acts as a crucial step for volunteer firefighters in Montana toward securing their financial well-being post-service, recognizing their invaluable contributions to the community.

Question	Answer
Form Name	Montana Form 1024
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	actuarially, 15th, false, 6041A

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Montana Public Employee Retirement Administration

PO Box 200131 • Helena MT 59620-0131

(406)444-3154 • Toll Free (877) 275-7372 http://mpera.mt.gov

VOLUNTEER FIREFIGHTERS’ COMPENSATION ACT (VFCA)

APPLICATION FOR PENSION BENEFITS

Dear Volunteer Firefighter:

Thank you for your service as a volunteer firefighter! The following information includes instructions for completing your Application for Pension Benefits as well as information regarding the terms and conditions of receiving your benefit. Please carefully read the following information, complete the application and return it to the Montana Public Employee Retirement Administration (MPERA) at the address shown above.

Important Information About Your VFCA Benefits

If you meet the service or age requirements, you do not need to be an active member of a fire company when you apply for pension benefits. However, you may not continue to be an active member of any fire company once you start receiving a pension benefit.

You are eligible to receive a full pension benefit after completing at least 20 years of credited VFCA service and reaching age 55. You will receive the full pension benefit for your lifetime. Your base pension monthly benefit will be $150 per month.

For each year of credited service beyond 20 years, and up to 30 years, your benefit will increase by $7.50 per month.

For each year of service beyond 30 years, your benefit may increase an additional $7.50 per month. Eligibility for this additional benefit will be determined annually, based on the pension trust fund being actuarially sound and amortizing within 20 years or less. (This additional benefit applies only if you retire on or after July 1, 2011.)

You can retire with a partial pension benefit after completing at least ten years, but less than 20 years, of credited VFCA service and reaching age 60.

(§§ 19-17-401, 19-17-404, MCA)

Benefit Payment Information

Pension benefits are sent on the last working day of the month and are subject to state and federal taxes.

If you choose to retire and receive a monthly pension benefit, you must sign and return your completed retirement application to MPERA at least 30 days prior to your anticipated retirement date. Please include a:

Copy of your certified birth certificate

A voided check (if you elect direct deposit)

Form 1024

Page 1 of 6

Step 1: Complete Your Survivor Information

A survivorship benefit may be paid to your spouse or a dependent child. A dependent child is under 18 years of age, and is unmarried. Monthly benefits paid to a survivor will equal the member's full or partial pension benefit or disability benefit.

Survivorship benefits are limited to 40 months, including any benefit paid to the member before death. If a member receives benefits for 40 months, no survivorship benefit is available. At the request of the survivor, a lump sum payment for the survivorship benefit may be made instead of the monthly benefit payments.

Step 2: Direct Deposit Election

We are pleased to offer you the safety and convenience of direct deposit of your monthly benefit payment. You must complete this section of your Application for Pension Benefits to authorize MPERA to send your monthly payment to the identified financial institution for deposit in your account. The financial institution may be any bank, savings bank, savings and loan association or similar institution, or federal or state chartered credit union located in the U.S.

Forms received by the 15th of any month will be processed that month. Your payment will be electronically deposited into your bank account on the last business day of each month. MPERA will not send a separate notification that your payment has been deposited, unless the net amount of the payment changes.

SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS

Joint account holders should immediately advise both MPERA and the financial institution of the death of the payee. Payments deposited after the date of death must be returned to MPERA. A determination regarding any death benefit payable will be made by MPERA.

CANCELLATION

The direct deposit of your payment will continue until you notify MPERA, in writing, that you wish to change your account, or upon notification of your death. If you wish to change financial institutions, contact MPERA for a new Direct Deposit Agreement. If changing accounts, do not close your existing account until a payment has been deposited into your new account.

The financial institution may also cancel this agreement upon notification to you, the payee. Please notify MPERA if this occurs.

COMPLETING YOUR DIRECT DEPOSIT ELECTION -- PAYEE CERTIFICATION

By completing the information on the Application for Pension Benefits, I am requesting that MPERA directly deposit my payment from the identified retirement system to the identified financial institution. I certify that I am entitled to payment from the retirement system identified above; I have identified all joint account holders; and I authorize MPERA to make necessary adjustments to my account to collect deposits made in error.

If your payment is to be deposited into your checking account, attach a voided check. If it is to be deposited into your savings account, provide the routing number. Please note: MPERA cannot make direct deposits to banks outside the U.S.

Form 1024

Page 2 of 6

Step 3: Choose Your Tax Withholding

MPERA will not withhold federal and state income taxes from your pension benefit unless you elect withholding. Please select only one option for your federal and state income taxes.

Step 4: Required Documents and Signatures

This step must be completed or your application will be returned. Please include all of the required documents. All signatures must be witnessed by a non-beneficiary third party.

Form 1024

Page 3 of 6

Montana Public Employee Retirement Administration

PO Box 200131 • Helena MT 59620-0131

(406)444-3154 • Toll Free (877) 275-7372 http://mpera.mt.gov

VOLUNTEER FIREFIGHTER COMPENSATION ACT

APPLICATION FOR PENSION BENEFITS

MEMBER INFORMATION

Name - Last			First, MI			Social Security Number*
						-	-

Date of Birth			Fire Company You Are Retiring From
	/	/
Mailing Address

City						State	Zip Code

Daytime Phone Number				Email Address
(	)
	Last Credited Year of Service				Date of Retirement

Assuming all eligibility requirements have been met, your effective date of retirement will be the first day of the month following your termination. You may specify a later date. However, your retirement date cannot be earlier than the date you meet retirement eligibility.

SPOUSE INFORMATION

Last Name			First Name, MI							Social Security Number*
										-	-

Date of Birth			Daytime Phone Number							Email Address
/	/		(	)
Mailing Address

City							State			Zip Code

		DEPENDENT CHILDREN (required only if there is no spouse)

Name - Last			First Name, MI							Social Security Number*
										-	-

Date of Birth			Gender
/	/				 M			 F
					 M			 F
Name - Last			First Name, MI							Social Security Number*
										-	-

Date of Birth			Gender
/	/				 M			 F
					 M			 F
Name - Last			First Name, MI							Social Security Number*
										-	-

Date of Birth			Gender

/	/					M			F
						M			F

*For identification and tax purposes. §19-2-403(7) MCA, 26 USC § 6041A and 6109

Form 1024

Page 4 of 6

Direct Deposit Election

RETIREE INFORMATION

I request that MPERA deposit my payment into my account at the financial institution identified below. I certify that I am the account holder of this account and I have identified all joint account holders. I authorize MPERA to make necessary adjustments to my account to collect deposits made in error.

Last Name		First, MI		Social Security Number*
				-	-

Date of Birth		Retirement Number (leave blank if unknown)		Retirement System
/	/
Mailing Address			City	State		Zip Code

Daytime Phone Number

()

Signature

FINANCIAL INSTITUTION INFORMATION

 MPERA cannot make deposits to banks outside the U.S. 

Name of Financial Institution						Phone Number

Mailing Address					City	State	Zip Code

Account Type				Account Number		Routing Number
	Checking		Savings
	Checking		Savings

JOINT ACCOUNT HOLDER INFORMATION (if applicable)

I certify by signing this Application for Pension Benefits that I understand my responsibilities as a joint account holder to immediately advise both MPERA and the financial institution of the death of the payee and that payments deposited after the date of death must be returned to MPERA. I also understand providing false information or improperly receiving payment may be a criminal offense under Montana and federal law.

Last Name		First Name, MI						Social Security Number*
								-	-

Date of Birth		Gender						Daytime Phone Number
							F
/	/			M			F	(	)
/	/							(	)
Mailing Address					City			State		Zip Code

Signature

Attach a voided check here if checking account (do not staple).

Please do not attach a deposit ticket.

*For identification and tax purposes. §19-2-403(7) MCA, 26 USC § 6041A and 6109

Form 1024

Page 5 of 6

Tax Withholding

Federal Income Tax information. Please choose only one.

฀Do not withhold federal income tax.

฀Withhold federal income tax in the amount of $__________ per month.

฀Withhold federal income tax based on the tax tables for:

฀A married individual with _______ tax withholding exemptions.

฀A single individual with _______ tax withholding exemptions.

In addition to the amount withheld, withhold $_________ per/month.

State Income Tax information. Please choose only one.

฀Do not withhold State of Montana income tax.

฀Withhold State of Montana income tax in the amount of $__________ per/month.

฀Withhold State of Montana income tax based on (#) __________ of exemptions.

฀In addition to the amount withheld, withhold $_________ per/month.

Required Documents and Signatures

I have enclosed a copy of my certified birth certificate

I authorize one of the following:



I elect direct deposit.

I elect to receive paper checks by mail.

REQUIRED SIGNATURES

I certify that the information submitted herein is true and correct to the best of my knowledge. I understand to cancel this application I must notify MPERA in writing before I cash or receive my first monthly pension benefit.

I also certify that I have read and understand all of the information provided with this application.

Your Signature

Date

/ /

I certify that this individual has terminated service with the named fire company or will terminate service as of the designated date.

Name of Fire Chief

Fire Chief Signature

Date

/ /

Form 1024

Page 6 of 6

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1. The 2011 will require specific information to be inserted. Be sure the subsequent blanks are filled out:

2. After this part is completed, you're ready add the needed details in Date of Birth, Mailing Address, City, Name Last, Date of Birth, Name Last, Date of Birth, Name Last, Date of Birth, Daytime Phone Number, Email Address, State, Zip Code, DEPENDENT CHILDREN required only, and First Name MI allowing you to go to the next step.

3. In this particular stage, review Last Name, Date of Birth Mailing Address, First MI, Social Security Number, Retirement Number leave blank if, Retirement System, City, State, Zip Code, Daytime Phone Number, Signature, Name of Financial Institution, Phone Number, FINANCIAL INSTITUTION INFORMATION, and MPERA cannot make deposits to. Each of these will need to be filled out with utmost accuracy.

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Montana Form 1024 – Fill Out and Use This PDF

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