Laserfiche WebLink
NOTICE C�F APPQINTMENT 4� AUTHORIZED AGENT <br /> � IMRF Forrn 2.20 (Rev. 6/02) <br /> INSTRUCTIONS <br /> • Appointment of an Authorized Agent is to be made by adoption of a resolution by the governing body. <br /> • The clerk or secretary of the governing body must certity the appointment(see Certification below). <br /> • Mail the completed form to the Illinois Municipal Retirement Fund. <br /> • A copy of the compieted form should be retained by the employer. <br /> • If you have an Employer Access account through IMRF Online, you will need to update the account profile to refiect <br /> this change. <br /> Employ Na e � Employer IMRF I.D. Number <br /> �� �' , ��' �I� �����; <br /> Autho' ed A t's Fi t Name �Middle Initial Last Jr.,Sr.,II,etc. Social Security Number <br /> Mr rs,.� . • � j� ��, �� � <br /> �r.rnns. -�-- �(1C � . �,. S� ' — — <br /> Type of governing body <br /> Date pointment made. E�e rve date of a oiQt e t Po ition Title .r f -S <br /> � i I �`'�' `�i� i 7 .:�-�it� � �'S(._�._�✓�.�,5' �t� <br /> Powers an uties delegated to Authorized Agent pursuant to Sec.7-135 of Illinois Pension Code by goveming body(the Authorized <br /> Agertt must be a participant in IMRF to file a petition or cast a ballot): <br /> To file Petition for Nominations of an Executive Trustee of IMRF �Yes ❑ No <br /> To cast a Ballot for Electi of an Executive Trustes of IMRF �Yes ❑ No <br /> �A !1 �� f <br /> �� i _� r � � �� <br /> Signature of AutHorized Agent Date <br /> Certiflcation j — `� f ��--v v � <br /> I, ��'" G��G � ` —'�/`�do hereby csrtify that I am �( � � �—'�'/� <br /> (Name) (Clerk or Secretary) <br /> ofthe ��7`� ��" c�4'"�L� ���/ �CJ�� <br /> (Name of Employer) <br /> and the keeper of its books and records and the foregoing appointment and delegation were made by res ution dul adopted on the <br /> data indicated. �! <br /> SEAL �� � ��'��� <br /> \ <br /> Signature of Clerk or Secretary ^� <br /> Business address All corraspondence and communications with the Authorized A ent are to be addresssd as follows: <br /> Nama(if different from above) Position Title <br /> Mr Mrs <br /> Dr,/Ms. <br /> Busine�,s Address Telephone(include area code)+E�ct. <br /> #a- i G.: �.ctc��s��. �ta�z�� a�� - �{a-y-a�o � <br /> City Sta e and Zp 4 FAX(include area code) <br /> �-cci�r �i� (02.�23 i1 - �-{a-�-�-7`l({ <br /> Illlnois Munlcipal Retlrement Fund <br /> 2211 York Road,Suite 500,Oak Brook Illinois 60523-2337 <br /> IMRF Form 2.20 {Rev.6/02) Service Represeniatives 800/ASK-lMRF <br /> www.imrf.org <br />