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INSTRUCTIONS: ALABAMA STATEMENT OF WITHDRAWN SERVICE

Alabama state employees enrolled in either the Employees' Retirement System or the Teachers' Retirement System who have previously withdrawn their contributions can restore previously canceled credits by filing the form discussed in this article. This withdrawn service cannot be service credit which has been established with any other public retirement system. 

Alabama Statement Of Withdrawn Service Step 1: On the first blank line, enter your first, middle and last names.

Alabama Statement Of Withdrawn Service Step 2: On the second blank line, enter your complete address.

Alabama Statement Of Withdrawn Service Step 3: On the third blank line, enter your Social Security number.

Alabama Statement Of Withdrawn Service Step 4: Three statements are printed below. Place a check in the first set of blank parentheses if you have not established any other public retirement system credit utilizing previously withdrawn service.

Alabama Statement Of Withdrawn Service Step 5: Place a check in the second set of blank parentheses if you have established any other public retirement system credit utilizing previously withdrawn service.

Alabama Statement Of Withdrawn Service Step 6: Place a check in the third set of blank parentheses if you have established another public retirement system credit for part of your previously withdrawn service. Enter the number of years and months which have been transferred to this credit.

Alabama Statement Of Withdrawn Service Step 7: Enter your signature and the date. 

Alabama Statement Of Withdrawn Service Step 8: Once you have completed the form, it must be certified by a notary public. In the space below the solid line, they will enter the state and county, the date on which you appeared before them and your name. They will then sign the bottom of the form, provide the date on which their commission expires, and affix their seal.

Alabama Statement Of Withdrawn Service Step 9: File the form at the address given at the top of the form. 

Alabama Statement Of Withdrawn Service Step 10: Once your application has been processed, you will need to pay the cost of purchasing your previously withdrawn service. You will be assessed a fee of the amount previously withdrawn, along with eight percent interest compounded from the date of withdrawal to the date of payment. The total withdrawn payment must be made before your employment ceases.