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Service Retirement Application

Customer Name: JOHN DOE

Understand Tax Considerations For Rollovers

Read the Special Tax Notice: Your Rollover Options below and acknowledge that you have received and are able to access this notice below. Once you have read the Special Tax Notice: Your Rollover Options and affirm the Acknowledgement below, select the Next button to continue.

For More Information

Review CalSTRS booklet, Tax Considerations for Rollovers.
Access important publications from the Internal Revenue Service, including, but not limited to:

IRS Publication 575, Pension and Annuity Income
IRS Publication 590, Individual Retirement Arrangements
IRS Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans)

Find state tax law information at the California Franchise Tax Board.
Consult a professional tax advisor before taking a payment from CalSTRS.

Review

Conditions of Use


Right to Receive Paper Document You have the right to have this Special Tax Notice: Your Rollover Options provided as a written paper document. Although you have provided consent to receive this notice electronically, you may obtain a paper copy of the Special Tax Notice: Your Rollover Options upon request at no charge.
Right to Withdraw Your Consent You have the right to withdraw consent to receive electronic delivery of the Special Tax Notice: Your Rollover Options at any time. Withdrawal of your consent may delay processing of your application. If you would like to withdraw your consent to receive electronic delivery of the Special Tax Notice: Your Rollover Options, contact CalSTRS and request to receive this notice and application as a written paper document at no charge.
Scope of Your Consent Consent to receive electronic delivery of the Special Tax Notice: Your Rollover Options applies only to the particular transaction.
CalSTRS Contact Procedures If you have questions about the procedures for receiving a written paper document or to update your electronic information, contact CalSTRS.
Computer Requirements View myCalSTRS Computer Requirements needed to access and retain this Special Tax Notice: Your Rollover Options as an electronic document.

Acknowledgement
Select the check box below to acknowledge that you have received and are able to access the Special Tax Notice: Your Rollover Options.
	*	I acknowledge that I have received, read and understand the contents of the Special Tax Notice: Your Rollover Options provided by CalSTRS. This publication is made available to me electronically and in print for my records and information. (Developer note: Dynamic when rolling over) I also understand I have at least 30 days before distribution to consider the information provided in this notice and decide whether to elect a direct rollover to another retirement plan or have the amount distributed to me. The 30-day waiting period has been met or I waive the 30-day period.

* Required field to continue.

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