R-259-93 Illinois Municipal Retirement FundRESOLUTION 5G1
ILLINOIS MUNICIPAL RETIREMENT FUND
100 South Wacker Drive - Chicago, Illinois 60606 -4093 312/346 -6722
OMITTED SERVICE CREDIT VERIFICATION
(See instructions on reverse side)
EMBER'S NAME
Jean M. Nona
SOCIAL SECURITY NUMBER
351-38-9352
MAILING ADDRESS CITY
9 Kettering Lane Lemont,
STATE
IL
ZIP + 4
60439
DATE CF BIRTH
03/15/47
TELEPHONE NO.
( 708) 257 -7902
OPTIONAL: ANTICIPATED RETIREMENT DATE:
NAME OF CURRENT RETIREMENT SYSTEM
I.M.R.F.
CURRENT POSITION
Treasurer
DATE PARTICIPATION BEGAN
IN CURRENT SYSTEM 04/01/83
EMPLOYER FOR WHOM SERVICE WAS RENDERED
Village of Lemont
OMITTED POSITION
Billing Clerk
EMPLOYER NUMBER ( STATE SSA NO.)
69 -033 4 426
VERIFICATION BY AUTHORIZED AGENT
I certify that the following statement of earnings for the above member are in agreement with the governmental 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*
1983
3704.00
9
1984
1895.00
4
*SE -
Npril 12 1993`x"
(seasonal leave explained on reverse
side
``
elms . - IDC nc Al r ..Ina ,cn en= ,
DAIt
RESOLUTION BY GOVERNING BODY
WHEREAS, the member should have been but was not reported to the Illinois Municipal Retirement Fund for a period of 13 months.
WHEREAS, employer contributions for the omitted service are payable to IIlkwis Municipal Retirement Fund through an adjustment to future employer
contribution rates.
RESOLVED, It Is the finding of this Village of Lemont that:
(NAME OF GOVERNING BODY)
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 Corms and documents with the
Illinois Municipal Retirement Fund.
CERTIFICATION BY CLERK OR SECRETARY OF GOVERNING BODY
Charlene M. Smollen
,the Clerk
• NAME CLERK OR SECRETARY
Village of Lemont
of
, do hereby certify that I am the keeper of Its
NAME OF GOVERNMENTAL UNIT
records and that the foregoing is a true and correct copy of a resolution duly adopted by Its governing body at a meeting held on the 12 day of
April .19 93
DATE
April 12. 1993
Clerk
CLERK OR SECRETARY
CERTIFICATION BY MEMBER
I fully understand that under the Illinois Pension Code I have the right to establish the entire quaffing period. This is to certify that I was
employed and received the above eamings from the above governmental unit from 0 4/01/81 through 0 4 /1(1/R 4
and ; that I,li agree, or ❑ disagree (please send letter of explanation) with the period verifi the governmental unit s oveming body.
April 12, 1993
\ DATE
SIG
URE OF MEM
IMRF Form 6.05 (Rev. 7/91)