Free 26716.pdf - Indiana

PRIMARY AND SECONDARY EDUCATION RETIREMENT PAYMENT TRANSMITTAL
State Form 26716 (R10 / 10-07) Approved by the State Board of Accounts, 2007

INDIANA STATE TEACHERS' RETIREMENT FUND 150 West Market St., Suite 300 Indianapolis, IN 46204-2809 Telephone: (317) 232-3860 / (888) 286-3544 Fax number: (317) 232-3882 Home page: www.in.gov/trf

INSTRUCTIONS: 1. Complete requested information 2. Sign and date the report 3. Attach your payment to the report 4. Use the reverse side to list checks 5. Forward your report and payment to the Fund by the due date Reporting units are ineligible to receive any distribution of money from the State of Indiana if this report and the retirement payment are not received by the due date. Name of unit Period covered: SCHOOL YEAR: July 1, _______ to June 30, _______ QUARTER: 1st July 1 / Sept. 30 ­ Payment Due October 15th 2nd Oct 1 / Dec 31 ­ Payment Due January 15th 3rd Jan 1 / Mar 31 ­ Payment Due April 15th 4th Apr 1 / Jun 30 ­ Payment Due July 15th RETIREMENT PAYMENT P-31 TOTALS TOTAL WAGES MANDATORY POST-TAX CONTRIBUTIONS @ 3% (EMPLOYEE CONTRIBUTIONS) MANDATORY PRE-TAX CONTRIBUTIONS @ 3% (EMPLOYER PICK-UP) TOTAL MANDATORY CONTRIBUTIONS EMPLOYEE VOLUNTARY POST-TAX CONT. EMPLOYEE VOLUNTARY PRE-TAX CONT. TOTAL VOLUNTARY CONTRIBUTIONS EMPLOYER SHARE (ERP) @ 7.25% FSP WAGES FSP CONTRIBUTIONS @ 7.25% TOTAL TEACHERS TOTAL SERVICE DAYS PAYMENT DIFFERENCE (Please explain) Account number

I hereby certify that the quarterly gross salary, annuity account contribution, and retirement funding are correct for the teachers and administrators who are eligible for membership and service credit in the Indiana State Teachers' Retirement Fund. Signature of School Corporation Treasurer or Township Trustee Contact person Telephone number Date signed (month, day, year) Fax number

NOTE: If you have any changes of address or key personnel to report, please attach the appropriate changes.