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Forms & Publications

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2023 California Tax Withholding Certificate

2023 Federal Tax Withholding Certificate

Beneficiary Designation Form

Address Change Form (Deferred Members)

Address Change Form (Retired Members)

Direct Deposit Authorization Form

Disability Retirement Application

Domestic Relations Order (DRO) Model A (Active Members) Form

Domestic Relations Order (DRO) Model B (Retired Members) Form

Estimate Request Form

Medicare Part B Reimbursement Form

Membership Certification Form

Member Waiver Form

Retirement Application Request Form

Return to Active Membership Application

RPESJC Deduction Form

Service Credit Purchase Request Form

Special Power of Attorney Form

United Way Deduction Form

San Joaquin Country Employees’ Retirement Association

6 S. El Dorado Street, Suite 400, Stockton, CA 95202

Phone: (209) 468-2163  Fax: (209) 468-0480  Email: ContactUs@sjcera.org

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