Forms
You may mail, scan, or email any form below unless otherwise stated in the form description and instructions. Only use the last four (4) digits of your social security number if you are emailing your forms otherwise you must fax or mail for security purposes. The following forms and applications are in Adobe Acrobat, printable format. To download a free version of Adobe, click here
       

ACTIVE MEMBERS
View File Contribution Balance Request - A3
Use this form if you need the amount of contributions you have paid into the system as of today.
View File Disability Application Packet
Use this application to apply for Disability benefits.
View File DROP Application
Use this form if you would like to enter the DROP Program.
View File Military Purchase Application
This form is for getting a cost to purchase your military service, a copy of your DD214 papers are required.
View File Personal Information Changes
If you need to make any changes to your retirement account including address change, marital status, beneficiary change, etc., please complete this form.  It must either be mailed or faxed.
View File Reciprocal Recognition
If you would like to enter into a reciprocal recognition with MERS and another Louisiana public pension fund which you have service credit, complete this form in triplicate and mail to MERS, 7937 Office Park Blvd., Baton Rouge, LA  70809.
View File Refund Application - Mandatory Direct Deposit
Use this form for refunds of contributions.  Effective March 1, 2014 all refunds must be direct deposit.  No exceptions.  If this form is not properly completed and signed, your refund will be delayed.    DO NOT USE THIS FORM FOR SURVIVOR REFUNDS.    
View File Repayment of Refund Calculation
If you would like to receive an invoice with the amount you would need to pay to restore service credit with MERS that was previously refunded, complete this form.
View File Retire from DROP Application
If you are currently participating in DROP and decide to retire before you have completed the length of participation you applied for, please complete this form.
View File Retirement Application
Please use this form when you want to apply for retirement benefits.  Preferably 2 months before your actually retirement date.  After completing your portion and attaching all required documentation, bring to your human resources department for final completion.  Applications received without the proper paperwork will delay processing.
View File Retirement/DROP Estimate Form
If you want an estimate of your retirement benefit, DROP benefit, or your additional benefit when you retire after continuing to work after you have completed the DROP program.
Estimates may be requested within 3 years of eligibility. 
View File Rollover of Refund
If you wish to rollover your sheltered contributions to another qualified plan when you terminate employment with your municipality, you must complete this form.  This form along with your financial institution's "Request to Transfer" form must be attached to your completed refund application.
View File Spousal Consent Form
This form must be attached to your retirement or DROP application if you have a legal spouse and you are choosing the Maximum Benefit.  It does not need to be completed if you are leaving your spouse at least 50% of your retirement benefit.  Please note that this form must be notarized or it will be returned and your application process will be delayed.
View File Survivor Benefits Application
Use form to apply for survivor benefits when an active member deceases.  Please call the office with any questions.
View File Survivor Refund Application
Use this form for refunds of contributions to survivors of deceased members.
View File Transfer of Service Credit
If you have service credit with another Louisiana public pension fund, you are eligible to request a transfer of service credit after you have contributed to MERS for six (6) months.
View File Trustee Transfer Form
This is to be used to repay a refund or pay for a transfer of service credit with sheltered funds you may have in a qualified plan.
View File Unclaimed Contributions Application
Use this form if you have located funds available on the LA Treasurer's "Unclaimed Property" website.
No information will be given over the telephone or through email.  This form must be received by our office with the proper documents attached before any information is released. This process may take 2-3 months to complete.
RETIRED MEMBERS
View File Direct Deposit Form
To be used to either begin electronic deposit of your benefit check or to change your bank and/or account number to your checking or savings account.
View File Drop Distribution
This form is to be completed if you would like to withdraw funds from your DROP account.  Please note that withdrawals are only processed on the first of each month.  This form must be received in our office no later than the 20th of the month to be processed by the 1st of the following month.

You would also use this form to rollover your funds into another qualified plan.
View File Drop Distribution - Survivor
This form is to be completed by a survivor of a member to withdraw funds from the member's DROP account.  Please note that withdrawals are only processed on the first of each month.  This form must be received in our office no later than the 20th of the month to be processed by the 1st of the following month.

You would also use this form to rollover your funds into another qualified plan.
View File Earnings Limit Request
To get the amount you can earn if you return to employment with a municipality in our system after you have retired.
View File Income Verification
If you are retired and you need income verification, please complete this form.
View File Retiree Important Reminders
Please read to keep updated on your responsibilities after retirement.
View File Retiree Update Form
Use this form to update your mailing address for mail outs, correspondence and annual 1099ís.  This form should also be used to report the death of your beneficiary.
View File Special Tax Notice
This notice explains your federal tax obligation when you withdraw funds from your DROP account.
View File W4P
IRS W4P is used to change your federal income tax withholdings from your retirement benefit.
EMPLOYERS
View File Conversion of Unused Leave
If your employer converts unused and unpaid leave upon retirement, this form must be completed and returned with the member's retirement application.
View File Enrollment Form
To enroll all new full-time employees or rehired employees into the retirement system.
THIS FORM MUST BE EITHER FAXED OR MAILED.  DO NOT EMAIL.
View File Forfeiture of Benefits Attestation
This is to be completed by all new employees hired January 1, 2013 to date.  DO NOT MAIL THIS FORM TO THE RETIREMENT SYSTEM.  IT MUST BE KEPT IN THE EMPLOYEE'S PERSONNEL FILE WITH THEIR EMPLOYER.
View File Municipality Contact Designation
This form is to be completed by the Mayor designating the Authorized Representative to certify employee information (applications, enrollment forms, refunds, etc.) and to designate one employee to receive all correspondence from this office to be distributed to the proper department.
View File Municipality Information
Please keep us updated with all changes of municipal contacts, address, etc.
View File Plan A DROP Monthly Report 7/1/16-6/30/17 PDF Format
To report monthly DROP employee salaries and employer contributions.

View File Plan A DROP Monthly Report 7/1/17-6/30/18
To report monthly DROP employee salaries and employer contributions.
Fiscal Year 7/1/17 - 6/30/18
View File Plan A Monthly Report 7/1/16-6/30/17 PDF Format
To report monthly employee salaries and employee and employer contributions.


View File Plan A Monthly Report 7/1/17-6/30/18
To report monthly employee salaries, employee, and employer contributions.
Fiscal Year 7/1/17 - 6/30/18
View File Plan A Retirees Returning to Work Monthly Report 7/1/16-6/30/17 PDF Format
To report monthly retirees that have returned to work salaries, employee, and employer contributions.  
View File Plan A Retirees Returning to Work Monthly Report 7/1/17-6/30/18
To report monthly retirees that have returned to work salaries, employee, and employer contributions.  Fiscal Year 7/1/17-6/30/18
View File Plan B DROP Monthly Report 7/1/16-6/30/17 PDF Format
To report monthly DROP employee salaries and employer contributions.

View File Plan B Monthly DROP Report 7/1/17-6/30/18
To report monthly DROP employee salaries and employer contributions.
Fiscal year 7/1/17 - 6/30/18
View File Plan B Monthly Report 7/1/16-6/30/17 PDF Format
To report monthly employee salaries, employee, and employer contributions.

View File Plan B Monthly Report 7/1/17-6/30/18
To report monthly employee salaries and employee and employer contributions.
Fiscal Year 7/1/17 - 6/30/18

View File Plan B Retirees Returning to Work Monthly Report 7/1/16-6/30/17 PDF Format
To report monthly retirees that have returned to work salaries, employee, and employer contributions.  Fiscal Year 7/1/16-6/30/17
View File Plan B Retirees Returning to Work Monthly Report 7/1/17-6/30/18
To report monthly retirees that have returned to work salaries, employee, and employer contributions.  Fiscal Year 7/1/17-6/30/18
View File Refund Application - Mandatory Direct Deposit
Use this form for refunds of contributions.  Effective March 1, 2014 all refunds must be direct deposit.  No exceptions.  If this form is not properly completed and signed, your refund will be delayed.
View File Return to Work Earnings
This form is used to report monthly gross earnings for any employee that has retired from MERS and has returned to either full or part-time employment with your municipality.  You should enter the gross monthly earnings, not the gross of their monthly pay checks.
View File Salary Evaluation
This must be attached to the member's retirement or DROP application.  It is used to verify the highest consecutive or joined months of salary.
View File SSA-1945
This form must be completed by all employees of municipalities that do not pay into social security. 
View File Status Change Form
To be included with your monthly reports to have employees records updated with leave without pay, termination dates, disability dates, etc.
MISCELLANEOUS
View File IRS Publication 575
This publication will answer your federal income tax questions.



   

 

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