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Get Employer's Certification Of Termination Of Employment For Retiring

And the employer/employee relationship will be completely severed, in accordance with the MERS Plan Document, Article III, Section 31 (see page 2), which I have read, and the Internal Revenue Code. Tribe Name Tribal Code No. Name of Employee (Last, First, Middle) Date of Birth (MM/DD/YYYY) Street Address Social Security No. (last 4 digits only) - City State Zip Code Last Day Worked or Paid For (MM/DD/YYYY) Date: Signature of Authorized Representative Printed Name.

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