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Get Employer Request For Forfeiture Of Member Benefits (VRS-180) - Varetire

Cial Security Number 2. Employer Code Complete this form to notify VRS that a member has been convicted of a felony for misconduct associated with the member s performance of job duties and that all VRS related benefits must be forfeited. This form is submitted to VRS after any appeals the member may make in regards to the termination of employment are closed. Additional information about employer responsibilities is attached. PART A. MEMBER INFORMATION 3. Name (First, Middle Initial, Las.

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