06-81 KATHY' S NOTE - SIGNATURE BLOCK PLACED ONTO THIS WORD DOCUMENT IN
CASE IT IS NEEDED FOR ATTACHMENT TO ADOBE RESOLUTION DOCUMENT
Resolution No. 06-81
IMFR out of state credit authorization for Sean R. Stegall
Kathy - See adobe C-14 for this resolution. There is no word
version of this document .
s/Ed Schock
Ed Schock, Mayor
Presented: April 12, 2006
Adopted: April 12, 2006
Omnibus Vote: Yeas: 7 Nays: 0
Attest:
s/Dolonna Mecum
Dolonna Mecum, City Clerk
M OUT-OF-STATE CREDIT AUTHORIZATION
FIMRF 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
Sean R. Stegall
Member Mailing Address City,State,and ZIP Current Position
Assistant City Manager
Current Employer Name Employer Number
City of Elgin 03347
Certification by Member
certify that I was an employee of 1 0 i /�7",�'�ji V Dt,� /2/_V
/ Name of Local Government /e.4
/v C ")d' from /1, �99Bto • 4 old',Name of State ��JJ� // to "Date
in the position(s)of nr,r,S/41
such service having been covered under /''G w /K. ,sT4/c 4‘7~,-/-
/� /e �� Name of Public Emplo ee Pension System
whose address is �T LS-�[ 42-2 9
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.
0:062 r l Q .gV2 93/_ s?3O
JMember's Signatur Member's Daytime Telephone No.
Certification by Clerk or Secretary of Governing Body
I certify that a regular or special meeting held on April 12, 200(he City Council
Date Name of Governing Body
of the City of Elgin, Illinois 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 May 18, 1998 to December 1, 200C(not to exceed 120
Date Date
months for the above named member).
April 12, 2006 Dolonna Mecum, City Clerk
Clerk or Secretary Signature
Illinois Municipal Retirement Fund
2211 York Road, Suite 500, Oak Brook Illinois 60523-2374, 630/368-1010
Service Representatives 800/A SK-IMRF (1-800-275-4673)
IMRF Form 6.33 (Rev. 6/99)
M 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
Sean R. Stegall
Member Mailing Address City,State,and ZIP Current Position
Assistant City Manager
Current Employer Name Employer Number
City of Elgin 03347
Certification by Member !! L 1�
I certify that I was an employee of �y G f *7 '/1./ea/ / Name of Local Government
lam^ from leg/ /1, /99Bto ° // ,2,100 Name of State // to • -bate
in the position(s)of / / Ch i /19/:
such service having been covered under /14 1.fV � ',.v i ,?44- 4 1 r-e-7,GsT 7C,1he-4
n [/ me of Public Emplo /lo ee Pension System J
whose address is /U s717 f�✓e e-71 /ace: 2-.2 7 t1
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.
0D 0(0 Member's Si natur Member's Daytime Telephone No.
9 Y P
I i
Certification by Clerk or Secretary of Governing Body
I certify that a regular or special meeting held on April 12, 2096 City Council
Date Name of Governing Body
of the City of Elgin, Illinois 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 May 18, 1998 to December 1, 2000(not to exceed 120
Date Date
months for the above named member).
April 12, 2006 Dolonna Mecum, City Clerk
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)
•
M OUT-OF-STATE CREDIT AUTHORIZATION
FIMRF 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
Sean R. Stegall
Member Mailing Address City, State,and ZIP Current Position
Assistant City Manager
Current Employer Name Employer Number
City of Elgin 03347
Certification by Member
I certify that I was an employee of •y Q 1 7'W/kt-� Ny
/�/ / Name of Local Government
✓ea/TL k from leg �O/ /996 _
to ri� r // m
Name of State //�� to -Date
in the position(s)of Ars:s"an r ail f/ i4 P/
such service having been covered under /VCW i'0/K. 3-7-x/e free >1.7e0-24,11--
/� 1 Name of Public Employee Pension System/� y
whose address is //U ...5-74•71€ f% e� A147 jt/ 4�.2
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
l required payment to IMRF.
-3 a i 6' gv2- 934 .s-'3o
/D a Member's Si natur Member's Daytime Telephone No.
g y
F-
1
Certification by Clerk or Secretary of Governing Body
I certify that a regular or special meeting held on April 12, 200§1e City Council
Date Name of Governing Body
of the City of Elgin, Illinois 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 May 18, 1998 to December 1, 200C(not to exceed 120
Date Date
months for the above named member).
April 12, 2006 Dolonna Mecum, City Clerk bi{-te44.is__
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)