COA ERS

City of Austin Employees' Retirement System

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Forms

	COA ERS Member Forms				About COA ERS Forms
	You need Acrobat Reader to view the Forms. If you do not have Acrobat Reader, you may download it by clicking on the icon below. Request for Purchase Calculation Estimate Request for Retirement Benefit Estimate Designation of Retirement Deposits (Vesting/Refund Form) (Revised April 2009) Beneficiary Designation Form (Revised May 2008) Beneficiary Designation Form - Minor Beneficiary Supplement (Revised May 2008) Authorization Agreement for Direct Deposit Disability Retirement Application Process (Revised June 2009) Change of Address Authorization for Retiree, Terminated Vested, and Proportionate Members) Name Change Authorization (for Retiree, Terminated Vested, and Proportionate Members) QDRO Policy QDRO Sample Form (Revised February 2008) Sample Employer's Order to Withhold from Earnings for Child Support IRS Form W-4P Withholding Certificate for Pension Payments COAERS Rollover Notice 2010 VENDOR INFORMATION Vendor Information/Conflict Disclosure Form				Note: Mail completed application(s) and form(s)to: City of Austin Employees' Retirement System 418 E. Highland Mall Blvd. Austin, TX 78752 -3720 PLEASE NOTE: IF YOU ARE AN ACTIVE CITY EMPLOYEE, YOU SHOULD BE SUBMITTING YOUR ADDRESS CHANGES TO YOUR PAYROLL OFFICE AND NOT THE RETIREMENT OFFICE. PLEASE CONTACT THE PAYROLL OFFICE AT 512-974-3001. ¿Habla Usted español? Representantes están disponibles para contestar sus preguntas en español por teléfono o aquí en la oficina de COAERS. Además, contamos con algunas formas en español y podemos dar presentaciones sobre el sistema y la jubilación para los miembros interesados. Favor de hablar al (512) 458-2551. Spanish Translated Forms Available.