Forms
Plan Document, Forms and
Applications available for Download
The City of Miramar
Police Officers' Retirement
Plan and Trust Fund
www.miramarpd.org
  1. Application for Service Buy-Back
  2. Rules and Regulations
  3. Prior Police Service Buy-Back Contract

Buy Backs
Buy Backs of Pension Credits for Time Spent in Police Service
Buy Backs of Pension Credits for Time Spent in Military Service
  1. Application for Service Buy-Back
  2. Rules and Regulations
  3. Military Service Buy-Back Contract

Retirement Package
  1. Application for Pension or Disability Benefits
  2. Affidavit of No Qualified Domestic Relations Order (QDRO)
  3. Beneficiary Designation Certificate
  4. Fiduciary Trust - Authorization Agreement for Direct Deposit Form
  5. 2016 IRS Form W-4P - Withholding Certificate for Pension and Annuity Payments
Below are some of the Forms used by the City of Miramar Police Officers' Retirement Plan and Trust Fund as well as a
copy of the Summary Plan Descriptions for both Tier I and Tier II Participants.  

To view these forms you must have the latest version of Adobe's Acrobat Reader installed.  If you do not have this
program installed in your computer, you may install this free program by clicking on the link below.
To view and download PDF documents,
you to click on the following link for a free
version of
Acrobat Reader.  We
recommend using the latest version.
Viewers with visual disabilities can go to
Adobe's Access Website for tools and
information that will help make PDF files
accessible.
DROP Entrance Package
DROP Exit Package
  1. Application for the Deferred Retirement Option Plan ("DROP")
  2. Affidavit of No Qualified Domestic Relations Order (QDRO)
  3. Beneficiary Designation Certificate
  4. Form Authorizing Transfer of Accumulated Leave Into DROP
    Account
  5. Fixed Rate of Return Election Form
  6. DROP Beneficiary Form
  1. Application for Pension Benefits After Separation of Employment
    For Participants with "DROP" Balances
  2. DROP Account - Election Form
  3. DROP Account - Statement of Consultation with Tax Advisor
  4. Affidavit of No Qualified Domestic Relations Order (QDRO)
  5. Fiduciary Trust-Direct Transfer/Withholding Authorization (Lump
    Sum / Hardship Distributions)
  6. Fiduciary Trust Authorization Agreement for Direct Deposit Form
  7. 2016 IRS Form W-4P - Withholding Certificate for Pension and
    Annuity Payments
  8. Harbor Notice
TIER I - Summary Plan Description
(for officers hired on or before June 9th, 2008)
TIER II - Summary Plan Description
(for officers hired after June 9th, 2008)
Disability Application Package
  1. Disability Retirement Application Acknowledgment Letter
  2. Application for Disability Retirement
  3. Release for medical information
  4. Physician report forms        
  5. Statement of disability by the employer
  6. Request for reasonable accommodation under the Americans With Disabilities Act