ࡱ> :<9i bjbj 8HfHfzz$G V\0$"fVp/Y ^B0G #V< # #G #z : TSERS RETIREMENT CHECKLIST (Please complete all forms and return to Human Resources) Contact HR is the first step NAME:__________________________________________ BANNER NUMBER:_______________________________ RETIRMENT DATE:_______________________________ Resignation Letter  FORMCHECKBOX  (HR will inform your department of your separation 30 days prior to your last day of work) Final Leave Report  FORMCHECKBOX  Prepare 101  FORMCHECKBOX  Retirement Application Form 6 and return to Benefits Manager in HR -Provide ID for yourself and Beneficiary  FORMCHECKBOX  -Return all completed forms mailed to your home back to the NC Treasurer Dept. -Medical Coverage: Orbit online/ or Call into State Health Plan  FORMCHECKBOX  -Apply for Medical Benefits if interested by calling (Please review rates and benefit comparison chart) 800-422-5249 -If over age 65, apply for Medicare Part A & B by calling Social Security Administration (Review Medicare Cost)  FORMCHECKBOX  -You will receive a CMS L564 from Social Security to return to HR for signature  FORMCHECKBOX  Gold Arts Card  FORMCHECKBOX  Longevity (If Applicable)  FORMCHECKBOX  Law Enforcement Officers Only & Other participating in 401K  FORMCHECKBOX  Special Separation Allowance LEO  FORMCHECKBOX  Prudential Letter Stating Resignation  FORMCHECKBOX  AFLAC  FORMCHECKBOX  Colonial  FORMCHECKBOX  Give information from Pierce Insurance for Dental and Vision Coverage  FORMCHECKBOX  Apply for Supplemental Benefits (Dental, Vision, ID Theft)  FORMCHECKBOX  Exit interview Received Retiree Packet__ (It takes 120 days to retire) Signature:____________________________________________ Date:________________________________________________ TUVrstuyz      ( ) * , / : S e u ؽܵܢܵjhdM1UhJjthdM1UhdM1jhdM1Uhxhe_jh] Ujh] Uh] hdhdhqL5 hqL5 h45hdhd5 h3'5;Utu    W Y q r  gd@WgdpKgddgd] $a$gdd     > E F T U V W X Y   q r   D E F T U V W X h i w ٙjhdM1Ujh] UjDh] U hlh] jh] Ujh] UhdM1h@Whdj\hT,UhT,jhT,Uh] hpKh 46;r W X , - f g EFUVgd@Wgddgd] w x y } ~       ) * + , - : S T U c d e f g l m n | } ~ ܫܠܑhjvhdM1Uh@WjhdM1UjhdM1UjhbUhbjhbUhJjhdM1UhdM1hdhe_h] jhdM1Uj,hdM1U3 234<BCDEFTUVoͶɮɮh4chhh@WjhRUjhRUhpKhRjbhdM1UhdM1hw~hJhdjhdM1UjhdM1U"6&P1h:pw~/ =!`"#@$% tDeCheck1tDeCheck2tDeCheck3tDeCheck4tDeCheck5tDeCheck8tDeCheck8tDeCheck8tDeCheck9vDeCheck17vDeCheck12vDeCheck13vDeCheck14vDeCheck15vDeCheck16tDeCheck8x2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List HH p M Balloon TextCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VGRU1a$N% ʣꂣKЛjVkUDRKQj/dR*SxMPsʧJ5$4vq^WCʽ D{>̳`3REB=꽻Ut Qy@֐\.X7<:+& 0h @>nƭBVqu ѡ{5kP?O&Cנ Aw0kPo۵(h[5($=CVs]mY2zw`nKDC]j%KXK 'P@$I=Y%C%gx'$!V(ekڤք'Qt!x7xbJ7 o߼W_y|nʒ;Fido/_1z/L?>o_;9:33`=—S,FĔ觑@)R8elmEv|!ո/,Ә%qh|'1:`ij.̳u'k CZ^WcK0'E8S߱sˮdΙ`K}A"NșM1I/AeހQתGF@A~eh-QR9C 5 ~d"9 0exp<^!͸~J7䒜t L䈝c\)Ic8E&]Sf~@Aw?'r3Ȱ&2@7k}̬naWJ}N1XGVh`L%Z`=`VKb*X=z%"sI<&n| .qc:?7/N<Z*`]u-]e|aѸ¾|mH{m3CԚ .ÕnAr)[;-ݑ$$`:Ʊ>NVl%kv:Ns _OuCX=mO4m's߸d|0n;pt2e}:zOrgI( 'B='8\L`"Ǚ 4F+8JI$rՑVLvVxNN";fVYx-,JfV<+k>hP!aLfh:HHX WQXt,:JU{,Z BpB)sֻڙӇiE4(=U\.O. +x"aMB[F7x"ytѫиK-zz>F>75eo5C9Z%c7ܼ%6M2ˊ 9B" N "1(IzZ~>Yr]H+9pd\4n(Kg\V$=]B,lוDA=eX)Ly5ot e㈮bW3gp : j$/g*QjZTa!e9#i5*j5ö fE`514g{7vnO(^ ,j~V9;kvv"adV݊oTAn7jah+y^@ARhW.GMuO "/e5[s󿬅`Z'WfPt~f}kA'0z|>ܙ|Uw{@՘tAm'`4T֠2j ۣhvWwA9 ZNU+Awvhv36V`^PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!g theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  w  r  )EUEUhx*Tdm}3CG$G G G G$G$G$G G G G G G G G G$8@0(  B S  ? Check2Check3Check4Check8Check9Check17Check12Check13Check14Check15Check16>hSg Vy+e~u{+/V333333su,/VWXYWXXh~+SelsuEWXYWXXy~ll~)(] T,;F HxdM1 46\67pIEpKqLp M+mMjU@W"^8^e_)g^fm9gxw~d~Rvi_l4xR=`dJ3'8Z(b4c__Grammarly_42____i__Grammarly_42___14H4sIAAAAAAAEAKtWckksSQxILCpxzi/NK1GyMqwFAAEhoTITAAAATH4sIAAAAAAAEAKtWcslP9kxRslIyNDYytTA3MTI2tzA2NrO0tDBQ0lEKTi0uzszPAykwqgUAEpbNoiwAAAA=@@UnknownG.[x Times New Roman5Symbol3. .[x Arial5. .[`)TahomaC.,.{$ Calibri Light7..{$ CalibriA$BCambria Math"hʒʒF   !`@243QHP ?d2!xx:  Alvita ByersMcNeill, Keyona R Oh+'0   @ L X dpx Alvita ByersNormalMcNeill, Keyona R2Microsoft Office Word@F#@^5>@*? @*?   ՜.+,0 hp  ncsa   Title  !"#$%&'(*+,-./02345678;Root Entry FIY =Data 1Table #WordDocument8SummaryInformation()DocumentSummaryInformation81CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q