R-260-93 Illinois Municipal Retirement FundRESOLUTION D. (. O
ILLINOIS MUNICIPAL RETIREMENT FUND
100 South Wacker Drive - Chicago, Illinois 60606 -4093 312/346 -6722
OMITTED SERVICE CREDIT VERIFICATION
(See instructions on reverse side)
SOCIAL SECURITY NUMBER
Rosenay Yates 1
356 -34 -9970
MAILING ADDRESS CITY STATE ZIP +4
904 Hillview Drive, Lemont, IL 60439
DATE OF BIRTH
05/19/43
TELEPHONE NO.
( 708 ) 257 -6585
OPTIONAL: ANTICIPATED RETIREMENT DATE:
NAME OF CURRENT RETIREMENT SYSTEM
I.M.R.F.
CURRENT POSITION
Secretary
DATE PARTICIPATICt'1 BEGAN
IN CURRENT SYSTEM 05/01/88
EMPLOYER FOR WHOM SERVICE WAS RENDERED
Village of Lemont
OMITTED POSITION
P -T Clerk
EMPLOYER NUMBER ( STATE SSA NO.)
69-033 4_42h
1091.75
VERIFICATION BY AUTHORIZED AGENT
I certify that the following statement of earnings for the above member are in agreement with the govemmental unit's
payroll records and represents the entire qualifying employment period determined by the governing body.
CALENDAR
YEAR
EARNINGS
MONTHS OF CREDITABLE SERVICE
CALENDAR
YEAR
EARNINGS
MONTHS OF CREDITABLE SERVICE
WITH
EARNINGS
WITHOUT
EARNINGS'
WITH
EARNINGS
WITHOUT
EARNINGS*
1985
1091.75
3 _.
1986
4496.91
12
1987
5150.46
12
1988
2094.55
4
*SE •
April 12, 1993
_
(seasonal leave explained on reverse
side)
/ ��
_ .__
CV'SAlen irr nc M at7 r:FUT /
//
RESOLUTION BY GOVERNING BODY
WHEREAS, the member should have been but was not reported to the Illinois Municipal Retirement Fund for a period of 31 months.
WHEREAS, employer contributions for the omitted service are payable to Illinois Municipal Retirement Fund through an adjustment to future employer
contribution rates. Village of Lemont
RESOLVED, It is the finding of this g
(NAME OF GOVERNING BOGY)
1. The member worked In an Illinois Municipal Retirement Fund qualifying position during the years and months set forth above.
2. The member Is currently employed in an IMRF qualifying position or a system that has reciprocity with IMRF.
FURTHER RESOLVED, that the authorized agent Is directed to file a certified copy of this resolution and any pertinent forms and documents with the
18inois Municipal Retirement Fund.
that:
CERTIFICATION BY CLERK OR SECRETARY OF GOVERNING BODY
Charlene M. Smollen
NAME
Village of Lemon
the Clerk
CLERK OR SECRETARY
do hereby certKy that I am the keeper of Its
of
NAME OF GOVERNMENTAL UNIT
records and that the foregoing is a true and correct copy of a resolution duty adopted by its governing body at a meeting held on the
April is 93
April 12, 1993 Clerk
DATE
CLERK OR SECRETARY
12th day of
CERT1RCATION BY MEMBER
I fully understand that under the Illinois Pension Code I have the right to establish the entire qualifying period. This is to certify that I was
employed and received the above eamings from the above govemmental unit from 09/16/85z through 04/10/88
and ; that I E agree, or 0 disagree (please send letter of explanation) with the period verified the ap(remmental unit's goveming body.
April 12, 1993
DATE
IMRF Form 6.05 (Rev. 7/91)
SIGNATURE F MEMBER
J