Group number:
  Group 1    Group 2    Group 4
 
Veteran Status:
  Non-Veteran  Veteran
  
 
Date of retirement:
Month
Day
Year(yyyy)
  
Date of birth:
Month
Day
Year(yyyy)
 
 
Number of years of creditable service:
  
Average of three highest consecutive years salary:
(omit $ sign, commas; for example, 75000.00)
$ 
  
 
Beneficiary age: (For Option C calculation only)
Beneficiary's date of birth or Beneficiary's Age at your date of retirement
Month
Day
Year(yyyy)
Age
Months
 
RETIREMENT ESTIMATES:
Option A
Option B
Option C
Annual Allowance
$
$
$
Monthly Allowance
$
$
$
*Beneficiary Annual Allowance
N/A
Balance Annuity Reserve Account, if any
$
*Beneficiary Monthly Allowance
N/A
$

Middlesex County Retirement Board
25 Linnell Circle - P.O. Box 160 - Billerica, MA 01865

(978) 439-3000 or (800) 258-3805
mrs@middlesexretirement.org