STANCera

StanCERA Forms

Forms may be completed on-line and			On-line submission of forms not available.
sent by mail or fax to:

StanCERA
P. O. Box 3150
Modesto, CA 95353-3150

Fax: (209) 558-4976



Active & Deferred Members			Retired Members


Link to Personnel Forms by Employer			Authorization for Automatic Deposit

Buy Back Calculation Request			Stop Direct Deposit

Buy Back Calculation Request: AB2766			Tax Withholdings - 2012 W4P

Beneficiary Designation - Instructions			Beneficiary for $5,000 Death Benefit

Service Retirement Estimate for Vested Members

Service Retirement Packet
			Tax Worksheets:
Social Security Benefits Calculator			Simplified Method Worksheets, for taxability calculation of your taxed contributions:
			1099R Worksheet #1
All Members			Retired between Jul. 2, 1986 - Nov.18, 1996.

Change of Address			1099R Worksheet #2
			Retired on or after Nov. 19, 1996 with a spouse beneficiary continuance.
Change of Name
			1099R Worksheet #3
Request for Retirement Benefit Information			Retired on or after Nov. 19, 1996, with no continuance.
Due to Marital Dissolution
			IRS 2010 Publication 575
			Pension and Annuity Income
PERSONAL INFORMATION:
Please inform your employer of a new address, phone number,
name change, marriage or divorce in a timely manner. StanCERA			(Click below to access IRS Withholding Calculator)
imports these changes from your employer's records.
It is the member's responsibility to forward supporting forms and/or documentation for personal changes, as your employer is not required to do so. Need a form you don't see on this page? Call StanCERA at (209) 525-6393.