Fernandez, Pedro New Emp AcknowledgementCITY OF OKEECHOBEE
MUNICIPAL FIREFIGHTERS PENSION FUND
NEW EMPLOYEES' ACKNOWLEDGEMENT
OF PLAN MEMBERSHIP FORM
TO: Board of Trustees
1. I hereby acknowledge all the terms and conditions of the City of
Okeechobee Municipal Firefighters' Pension Fund, and
2 I have been furnished with a Summary Plan Description.
•
Signature of Merribe
NEW EMPLOYEE INFORMATION:
DATE OF HIRE;
DEPARTMENT:
JOB TITLE'
STARTING SALARY:
LEGAL NAME
DATE OF BIRTH:
SOCIAL SECURITY NO:
ADDRESS:
Date
dime I8� Zola
Fire.
Prokahonani Fiiretlk4i/Em.T
310 510 5 ANNUALLY
anan Fernavidez,
1
Board of Trustees:
DEmailed to Plan Administrator
on: by:
Date Accepted:
By:
00rlginal to Personnel File ❑Employee Copy with Pian
Summary attached