Forms For Active City Employees

Forms below are interactive -- you may type information directly onto the form. Once completed, print out the form, sign form (if applicable), and return it to LACERS via mail, fax, or in person.

Note: The following forms are in PDF format and are best viewed with Adobe Acrobat® 5.0 or later. Adobe Acrobat Reader can be downloaded for free by clicking on the icon below.

• Application to Purchase Previous City Service (Re-deposits and Back Contributions)
• Application to Purchase Public Service (Leaves of Absence Other than Maternity Leaves)
• Cancellation of Election to Participate in FDBIP
• Certification of Service (Government Service Buybacks and Establishment of Reciprocity)
• Certification of Service with the Pension Savings Plan
• Certification of Uncompensated Maternity Leave
• Checklist for New Retirees
• Declaration of Domestic Partnership
• Designation of Beneficiary for Active Members
• Distribution Election Form
• Election Not To Participate in DWP Reciprocity
• Election to Participate in FDBIP
• Family Death Benefit Insurance Plan (FDBIP)
• Form W-9 Instructions (Rev. January 2002)
• Form W-9 Request for Taxpayer Identification Number and Certification (Rev. January 2003)
• Larger Annuity - Initiation or Change of Contribution Amount
• Larger Annuity Program - Application to Purchase Larger Annuity
• Larger Annuity Program - Election to Change Investment Option or Terminate Biweekly Contributions
• Marital Status Declaration (Married/Domestic Partner)
• Marital Status Declaration (Single)
• Member Information Sheet
• Notice of Termination of Domestic Partnership
• Notice Regarding Possible Missing Retirement Contributions
• Retirement Option Selections
• Service Retirement Application
• Service Retirement Application/Aplicacion Para Jubilacion Por Servicio (Spanish version)
• Spousal Consent to Designate Non-Spouse Joint Annuitant for Larger Annuity
• Tax Notification