02-333 Resolution No. 02-333
iM OUT-OF-STATE CREDIT AUTHORIZATION
IMRF Form 6.33 (Rev. 6/99)
INSTRUCTIONS AND REQUIREMENTS ON REVERSE SIDE
PLEASE PRINT OR TYPE
•
Member's First Name Middle Intial Last Name Social Security Number"
Martin D. Gregory 339-44-8427
Member Mailing Address City, State,and ZIP Current Position
775 Scott Dr. Elgin, IL 60123 Asst. Finance Director
Current Employer Name Employer Number
City of Elgin, Illinois 03347
Certification by Member City of Memphis
I certify that I was an employee of •
Name of Local Government
Tennessee from October 4, 1972 to July 29, 1977
Name of State Date Date
in the position(s)of Budget Analyst, Principal Accountant, Accounting Supervisor
such service having been covered under City of Memphis Employee Retirement Fund
Name of Public Employee Pension System
whose address is 125 N. Main, Rm. 354 Attn: May Walls Memphis TN 38103
Street City State Zip Code
and that I have irrevocably forfeited all service credits in said pension system and am not entitled to benefits of any type
therefrom. I understand that no service credit will be established under the Illinois Municipal Retirement Fund until I have made the
required payment to IMRF.
•oZ "�4 847-931-5636
Date Member' ture Member's Daytime Telephone No.
Certification by Clerk or Secretary of Governing Body
certify that a regular or special meeting held on October 9, 20 0Ahe City Council
Date Name of Governing Body
of the City of Elgin, I 11 i no i s authorized the granting of service credits for out-of-state service with
Name of Governmental Unit
the out-of-state governmental unit named herein from October 4 , 197 2to July 29, 19 7 7 (not to exceed 120
Date Date
months for the above named member).
Octoler 10, 2002 Dolonna Mecum
Date Clerk or Secretary Signature
Illinois Municipal Retirement Fund
2211 York Road, Suite 500, Oak Brook Illinois 60523-2374, 630/368-1010
Service Representatives 800/ASK-IMRF (1-800-275-4673)
IMRF Form 6.33 (Rev. 6/99)