HomeMy WebLinkAbout2002-06-06 - Agendas - FinalFAYETTEVILLE
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THE CITY OF FAYETTEVILLE, ARKANSAS
FIRE PENSION AND RELIEF FUND BOARD
AGENDA
JUNE 6, 2002
A special meeting of the Fire Pension and Relief Fund Board will be held at 1:00 p.m. in
Room 326 of the City Administration Building located at 113 West Mountain Street,
Fayetteville, Arkansas.
1. Retirement of John Jenkins.
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113 WEST MOUNTAIN 72701 479-521.7700
FAX 479-575-8257
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APPLICATION FOR PENSION PURPOSES
Date 'rte — b 0 Z
Board of Trustees
Fire Pension and Relief Fund
Fayetteville, Arkansas
Gentlemen:
I, tTb N SEnie' S have been employed by the Fire Department of the City of
Fayetteville, Arkansas since (o — to — 1921
I hereby request all of the benefits due me from the Fire Pension and Relief Fund as of
10—to-07._
My Beneficiary is
ESL E & -b- K y c,E cE,v o lniS
My reasons for retirement are 20 115 pr 9to_Z_
pASignature
CJ ••
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j
its isQlub, ii e 8 sworn to before me this 64 day of �1-4-04 ,. , ��X
coau 0 s Notary Notary Public g�a/
OHINGI >' My commission expires
CITY CLERK/TREASURER'S OFFICE
Computation of Retirement Benefits
The monthly salary of the above applicant for pension purposes is $
One half of applicant's salary $
Additional benefits per Arkansas Act 396 of 1987 $
Additional benefits per Arkansas 24-11-418 (military time) $
Total retirement benefits $
City Clerk/Treasurer
Subscribed and swom to before me this day of
• Notary Public
My commission expires
Name:
Emp #
SS#
DOH:
Yrs Srv:
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John Jenkins
113
431-23-6787
06/07/82
20
GENERAL FIRE PENSION
Prepared:
Date of Retirement:
Hourly Rate: 13 28
Hours Base: 3,247.92
EMT/Hazmat Pa 520.00
Annual Salary
Annual Benefit (at 90% of salary)
1\12 of Annual Benefit
Additional yrs beyond 20:
Monthly benefit
Daily benefit
43,652.378
39,287.140
3,273 93
$20.00 0.00
3,273.93
107.64
06-03-02A08:21 RCVD
5/31/2002
06/07/02
• FIREMEN'S PENSION & R E L I EF F U N D
AFFIDAVIT
J0/,7L/✓-U18Al&//5 do solemnly swear that
I was a former member of the Fire Department of the City of
Fayetteville, Arkansas, and am presently receiving benefits from
the Fayetteville Firemen's Pension and Relief Fund.
MAILING ADDRESS:
TELEPHONE:
SOC. SEC. NO.:
DATE OF BIRTH:
a' 3 9 (o oeA0 40Ase r/7- RD
FAT a rage,>itE 6tR 72201
(479) S2/ &35-7
U3/ -23-(07g7
-/1-- S-9
BELOW ARE SHOWN ANY PERSONS WHO ARE MY BENEFICIARIES:
NAME/SOCIAL SECURITY NUMBER BIRTHDATE RELATIONSHIP
Ecn/ — (4 31 33 939 c,�i ///-25--(9° CV' fe-
1111 KY`6 — 430 73559? f,,,d /-2/-2°f .50n)
C.
Si nature
Da e
84'54 ,AND SWORN TO before me,a Notary Public, this 3d ' jj day
z
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- 0n Expires: %0.4g, O/ 6e4..eu.se�
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(This affidavit is required annually by the Firemen's Pension and
Relief Fund Board of Trustees and must be properly executed and
returned to the Fayetteville City Clerk, 113 West Mountain,
Fayetteville, Arkansas.)