HomeMy WebLinkAboutDocumentation_Pension Public Safety_Tab 04_05/21/2002 ~4~~
VII,LAGE OF TEQUESTA
PUBLIC SAFETY OFFICERS PENSION TRUST FUND
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
I, , do hereby request to participate in the Public
Safety Officers' Pension Trust -Fund of the Tillage of Tequesta on the date as of which I
am eligible to begin participation under the terms of the Plan. I understand the general
provisions of the Plan as provided to me and agree to the provisions of the Plan.
In the event of my death prior to termination of employment, I hereby designate the
following Beneficiary(ies) to receive my death benefit from the Plan:
Name of Participant:
Address:
Date of Birth: Date of Employment:
Primary Beneficiary: Relationship: - -
Address: -_ ~ -
Contingent Beneficiary(ies):
Address:
The right is reserved to revoke this designation and subject to due notice to the Trustee to
designate a new beneficiary.
Date Signed Signature of Participant Social Security Number
e itnessed Signature of Wit ess: fI'i 'al
Or Notary Public
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Memo This document contains time-sensitive information. Please read
immediately and respond as specified.
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To Dan Gallagher, Project Accountant
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From Kim Bodinizzo, Human Resources Coordinator ~----~ -
Date/Time May 13, 2002
Subject Public Safety Officers' Pension Trust Fund Enrollment and
Beneficiary Designation Form; Charles Patrick Malley
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~~ n Attached please find an Enrollment and Beneficiary Designation Form for
` Charles Patrick Malley. Mr. Malley began employment on May 6,
2002, in the position of Police Officer.
/krb
Attachment
II.,LAGE OF TEQUESTA
PUBLIC SAFETY OFFICERS'
PENSION TRUST FUND
ENROLLMENT AND BENEFICIARY DESIGNATION FORM
PLEASE CHECK WHICHEVER APPLIES TO YOU:
Police Department Employee
Fire Department Employee
I -~ ' ' . ~ , ~ , do hereby request to participate in the Public
Safety Officers' Pension Trust Fund of the Village of Tequesta on the date as of which I
am eligible to begin participation under the terms of the Plan. I understand the General
Provisions of the Plan as provided to me and agree to the Provisions of the Plan.
In the event of my death prior to termination of employment, I hereby designate the
following Beneficiary(ies) to receive my death benefit from the Plan:
Name of Participant: ~ 10,E 1 ~ ~ ~~' ~ ~ ~'
Address: ; ' ` ~ + '
Date of Birth: c 4 <=, :: ,, ~<, ~~ = Date of Employment: (` t- ,) i+ ;
Primary Beneficiary: ,~_ : v . ~ ~, ~- -_ ~ ~ Relationship: ~ . a ~ - c• -
Address: ,' ~ ~ ~ [" 1' ~ -~j~r t: ~I ~ : ,- f: ~ ~~ ~:
Contingent Beneficiary(ies)~
Address: i` I `~' -`' ~~
The right is reserved to revoke this designation and subject to due notice to the Trustee to
designate a new beneficiary.; ,, ~: r
~,
Date
--~ ,~- ~
Social Security Number
Date Witnessed Signatu f Witness: Plan Official
Or Nota Public
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VILLAGE OF TEQUESTA
PUBLIC SAFETY OFFICERS' PENSION TRUST FUND
CASH FLOW SCHEDULE
FYE SEPTEMBER 30, 2002
SECURITIES
BEGINNING FUNDS BOUGHT/ INCREASED ENDING
MONTH ! BALANCE INCOME DISTRIBUTION ADDED I (SOLD) VALUE BALANCE
OCTOBER 1,457,148.88 4,076.76
NOVEMBER 1,480,797.62 3,771.80
DECEMBER 1,550,290.07 2,829.67
JANUARY 1,570,219.82 3,922.43
FEBRUARY 1,571,083.86 2958.19
MARCH 1,556,630.67 3701.58
APRIL
0.00 7,663.58 (38,962.76)
1,485.17) 8,877.65 (39,265.07)
0.00 7,755.26 4,532.07
7,957.12) 37,293.36 0.00
(242.37) 8,611.20 37,947.40
4,403.86) 6,552.10 3,010.17
50,871.16 1,480,797.62
97,593.24 1,550,290.07
4, 812.75 1, 570, 219.8 2
32,394.63) 1,571,083.86
49,274.42 1,556,630.67
8,859.99 1,563,542.03