Get Ccpoa Retirement Benefits

California Correctional Peace Officers Association 755 Riverpoint Dr West Sacramento CA 95605-1634 800 821-6443 916 372-6060 Fax 916 372-6623 Member Effective Date MEMBERSHIP APPLICATION CCPOA USE ONLY CALIFORNIA CORRECTIONAL PEACE OFFICERS ASSOCIATION RETIRED CHAPTER PAYROLL DEDUCTION AUTHORIZATION/MEMBERSHIP APPLICATION I hereby apply for membership in the California Correctional Peace Officers Association Retired Chapter and authorize a monthly deduction of 10. 00 from my retirement warrant received through the Public Employees Retirement System PERS. The 10. I understand PERS cannot process a termination notice received directly from me and that excess deductions taken in error will be refunded to me by the association and not PERS. This authorization will remain in effect until canceled by the Association at my written request. I understand termination of membership will cancel all deductions made under this organization. RECEIVED BY CCPOA Print Name First Last Name M. I. Street Address Apt State Home Phone Job Class/Title Beneficiary Signed Zip Moblie/Other Phone City Birth Date SSN E-Mail Last Employed At Last CCPOA Chapter CCPOA Member Since Retirement date Relationship Phone Number Date. I hereby authorize the Public Employees Retirement System PERS to withhold from my Retirement Warrant in accordance with the rules of said system deduction for retiree benefits until such time as I file in this same office a written request for termination. I also authorize the Association to certify to PERS the amount of the deduction and any subsequent changes to that amount. I understand PERS cannot process a termination notice received directly from me and that excess deductions taken in error will be refunded to me by the association and not PERS. This authorization will remain in effect until canceled by the Association at my written request. I understand termination of membership will cancel all deductions made under this organization. RECEIVED BY CCPOA Print Name First Last Name M. California Correctional Peace Officers Association 755 Riverpoint Dr West Sacramento CA 95605-1634 800 821-6443 916 372-6060 Fax 916 372-6623 Member Effective Date MEMBERSHIP APPLICATION CCPOA USE ONLY CALIFORNIA CORRECTIONAL PEACE OFFICERS ASSOCIATION RETIRED CHAPTER PAYROLL DEDUCTION AUTHORIZATION/MEMBERSHIP APPLICATION I hereby apply for membership in the California Correctional Peace Officers Association Retired Chapter and authorize a monthly deduction of 10. 00 from my retirement warrant received through the Public Employees Retirement System PERS. The 10. 00 deduction is payment for participation in the retiree life insurance policy and other retiree membership benefits which may be available. I hereby authorize the Public Employees Retirement System PERS to withhold from my Retirement Warrant in accordance with the rules of said system deduction for retiree benefits until such time as I file in this same office a written request for termination* I also authorize the Association to certify to PERS the amount of the deduction and any subsequent changes to that amount.