State of Connecticut Comptroller's Retirement Services Division Forms

Comptroller's Retirement Services Division Forms

For the PDF files included in this index:

Access.Adobe.Com is a tool that allows blind and visually impaired users to read any document in Adobe PDF format. The tool converts PDF documents into simple HTML or ASCII text, which can then be read by a number of common screen reading programs that synthesize the HTML as audible speech.
There are three ways to use Access Adobe:: By form submission,; By email or; By an Acrobat for Windows plug in.
Please go to: http://access.adobe.com for more information.

Retirement Services Division Forms are in the midst of being updated and redesigned. For more information link to: Retirement and Benefit Divisions Forms memorandum dated September 12, 2008.

Most of these forms have been designed to allow you to complete the form online and then print the form for any necessary signatures. You may also print a blank copy of any of these forms to be completed manually.

FORM NUMBER	CATALOG NUMBER	FORM NAME		FILE SIZE	SOURCE DOCUMENT
CO-628 Rev 3/2009	N/A	APPLICATION FOR REFUND OF RETIREMENT CONTRIBUTIONS - Tier I Members Only WORD format
CO-628a New 3/2009	N/A	APPLICATION FOR REFUND OF RETIREMENT CONTRIBUTIONS -Tier II Hazardous Duty Members Only WORD format
CO-628b New 3/2009	N/A	APPLICATION FOR REFUND OF RETIREMENT CONTRIBUTIONS - Tier IIA Members - Non Vested Only WORD format
CO-628c New 3/2009	N/A	APPLICATION FOR REFUND OF HAZARDOUS DUTY RETIREMENT CONTRIBUTIONS WORD format
CO-898 New 2/09	N/A	APPLICATION FOR RETIREMENT BENEFITS WORD format
CO-898a New 6/09	N/A	APPLICATION FOR ALTERNATE RETIREMENT PROGRAM RETIREMENT BENEFITS WORD format
CO-899 Rev 11/08	N/A	INCOME PAYMENT ELECTION FORM - OPTION A - 50% SPOUSE
CO-899 Rev 11/08	N/A	PDF format	WORD format
CO-899P New 12/09	N/A	INCOME PAYMENT ELECTION FORM - OPTION A - 50% SPOUSE
CO-899P New 12/09	N/A	WORD format
CO-900 Rev 05/09	N/A	INCOME PAYMENT ELECTION FORM - OPTION B - 50% OR 100% SURVIVOR
CO-900 Rev 05/09	N/A	PDF format	WORD format
CO-900P New 12/09	N/A	INCOME PAYMENT ELECTION FORM - OPTION B - 50% OR 100% SURVIVOR
CO-900P New 12/09	N/A	WORD format
CO-901 Rev 11/08	N/A	INCOME PAYMENT ELECTION FORM - OPTION C - 10 TO 20 YEARS PERIOD CERTAIN
CO-901 Rev 11/08	N/A	PDF format	WORD format
CO-901P New 12/09	N/A	INCOME PAYMENT ELECTION FORM - OPTION C - 10 TO 20 YEARS PERIOD CERTAIN
CO-901P New 12/09	N/A	WORD format
CO-902 Rev 11/08	N/A	INCOME PAYMENT ELECTION FORM - OPTION D - STRAIGHT LIFE ANNUITY
CO-902 Rev 11/08	N/A	PDF format	WORD format
CO-902P New 12/09	N/A	INCOME PAYMENT ELECTION FORM - OPTION D - STRAIGHT LIFE ANNUITY
CO-902P New 12/09	N/A	WORD format
CO-931 Rev 7/98	570-02	DESIGNATION OF RETIREMENT SYSTEM- TIER-PLAN-BENEFICIARY PDF format		35 Kb	Retirement and Benefit Services Memorandum dated November 17, 2008
CO-1047 Rev 05/09	N/A	SPOUSE WAIVER OF MONTHLY SURVIVOR BENEFITS
CO-1047 Rev 05/09	N/A	PDF format	WORD format
CO-1047P New 12/09	N/A	SPOUSE WAIVER OF MONTHLY SURVIVOR BENEFITS
CO-1047P New 12/09	N/A	WORD format
CO-1049 Rev 10/2009	N/A	LIMITED DURABLE POWER OF ATTORNEY (LDPOA)
CO-1049 Rev 10/2009	N/A	PDF format	WORD format
CO-1060 New 7/2009	N/A	FINANCIAL AFFIDAVIT FORM Explanation- Word format
CO-1060 New 7/2009	N/A	PDF format	WORD format
CO-1068	N/A	RETIREMENT - DIRECT DEPOSIT AUTHORIZATION AND INPUT FORM - PDF format		114Kb	N/A
CO-1082 Rev 6/04	N/A	RETIREE/ANNUITANT ADDRESS CHANGE FORM		15 Kb
CO-1082 Rev 6/04	N/A	PDF format	WORD format	15 Kb
CO-1088 New 8/98	800-10	RETIREMENT CREDIT PURCHASE REQUEST- PRIOR MISC SERVICE PDF format		75 Kb	Retirement Division Tier 2A Memorandum
CO-1089 New 8/98	800-11	RETIREMENT CREDIT RESTORATION REQUEST PDF format		67 Kb	Retirement Division Tier 2A Memorandum
CO-1090 New 8/98	800-12	RETIREMENT CREDIT PURCHASE REQUEST- LEAVES WITHOUT PAY PDF format		69 Kb	Retirement Division Tier 2A Memorandum
CO-1093 New 7/2007	N/A	FEDERAL AND CONNECTICUT TAX WITHHOLDING CHANGE FORM		38 Kb
CO-1093 New 7/2007	N/A	PDF format	WORD format	38 Kb
CO-1200 New 10/2009	N/A	APPLICATION FOR MERS RETIREMENT BENEFITS (PART B)
CO-1200 New 10/2009	N/A	PDF format	WORD format
CO-1201 Rev 10/2009	N/A	MERS INCOME PAYMENT ELECTION FORM - Option A
CO-1201 Rev 10/2009	N/A	PDF format	WORD format
CO-1202 Rev 10/2009	N/A	MERS INCOME PAYMENT ELECTION FORM - Option B
CO-1202 Rev 10/2009	N/A	PDF format	WORD format
CO-1203 Rev 10/2009	N/A	MERS INCOME PAYMENT ELECTION FORM - Option C
CO-1203 Rev 10/2009	N/A	PDF format	WORD format
CO-1204 Rev 10/2009	N/A	MERS INCOME PAYMENT ELECTION FORM - Option D
CO-1204 Rev 10/2009	N/A	PDF format	WORD format
CO-1205 Rev 10/2009	N/A	SPOUSE WAIVER OF MONTHLY SURVIVOR BENEFIT (MERS)
CO-1205 Rev 10/2009	N/A	PDF format	WORD format
CO-1206 New 10/2009	N/A	CERTIFICATION OF MARITAL STATUS (MERS)
CO-1206 New 10/2009	N/A	PDF format	WORD format
CO-1207 New 10/2009	N/A	APPLICATION FOR MERS RETIREMENT BENEFITS (PART A)
CO-1207 New 10/2009	N/A	PDF format	WORD format
CO-1208 New 1/10	N/A	TEMPORARY POST RETIREMENT REEMPLOYMENT		70 Kb
CO-1208 New 1/10	N/A	WORD format		70 Kb

This page was last updated on: March 03, 2010
Back to Comptroller's Home Page