Illinois Municipal Retirement Fund (IMRF) Social share icons You must have JavaScript enabled to use this form. Leave this field blank Annuitant Deduction Authorization Illinois Public Employees Retiree Chapter 31 American Federation of State, County & Municipal Employees 615 South Second Street, P.O. Box 2328, Springfield, IL 62705-2328 Illinois Municipal Retirement Fund (IMRF) Retiree Name First Name Middle Initial Last Name Home Address Apartment, Suite, etc. City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Postal Code Social Security Number (Last 4 digits only) (Required by the retirement system) Birth Date Retirement Date If Surviving Beneficiary of Retiree, Check Here Personal Email Home Phone Cell Phone † † By providing your cell phone number you consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. Your carrier’s rates may apply. You may modify my preferences at: https://www.afscme.org/tcpa. By providing my cell phone number I consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. My carrier’s rates may apply. † By providing your cell phone number you consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. Your carrier’s rates may apply. You may modify my preferences at: https://www.afscme.org/tcpa. Authorization I hereby authorize the Illinois Municipal Retirement Fund to deduct each month the amount certified by the Retiree Chapter as the current rate of dues. This deduction is to be turned over to the Public Employees Retiree Chapter 31, AFSCME. Signature Reset My electronic signature is a binding and valid signature. By signing here I agree to all of the terms and conditions set out in this authorization, which apply to my membership, dues payments and, if applicable, PEOPLE payments. Submit
