GERS_Disability_Earnings_Report
DISABILITY EARNINGS REPORT EMPLOYEES' RETIREMENT 5¥ STEM OF THE GOVERNMENT OF THE VIRGIN ISLANDS 48B-50C Kronprindsens Gade Charlotte Amalie, St. Thomas, U. 5. V. 1. 00802 Phone #809-776-7703 Fax # 809-776-4499 INSTRUCTIONS: (1) If you received a disability pension for the entire calendar year, indicate any and all earnings from gainful employment. (2) If you retired with disability pension during the calendar year, indicate only those earnings from gainful employment hfter your retirement date. (3) If you had no earnings, indicate "NONE" in the space provided. TO THE BOARD OF TRUSTEES: In accordance with the provisions of Title 3, Chapter 27, Section 711 (b) of the Virgin Islands Code (as extracted below) |, the undersigned do swear and affirm that while receiving my disability annuity, | earned $ in the calendar year from gainful occupation. Social Security No. — Name Date Signature a Street or P. QO. Box No. i City, State & Zip Code Extract from Title 3, Chapter 27, Section 711 (b). …
Download the original document · Plain text (TXT) · Browse the archive · How this archive works
Original source: https://www.usvigers.com/wp-content/uploads/2021/07/GERS_Disability_Earnings_Report.pdf
SHA-256 c4fd66ed8925b47e96dae90a94f49520bc8c28a5f6bc6973ec3f7cae3a6fad52
Re-using this document
RIGHTS UNSTATED (territorial): a V.I. instrumentality, no terms page, publishes as a territorial public record (H11)
Our description, tagging, arrangement, extracted text and machine transcripts are released under CC0 1.0. We assert nothing about the document itself.
Archive identifier LF-c4fd66ed8925
Document text
DISABILITY EARNINGS REPORT EMPLOYEES' RETIREMENT 5¥ STEM OF THE GOVERNMENT OF THE VIRGIN ISLANDS 48B-50C Kronprindsens Gade Charlotte Amalie, St. Thomas, U. 5. V. 1. 00802 Phone #809-776-7703 Fax # 809-776-4499 INSTRUCTIONS: (1) If you received a disability pension for the entire calendar year, indicate any and all earnings from gainful employment. (2) If you retired with disability pension during the calendar year, indicate only those earnings from gainful employment hfter your retirement date. (3) If you had no earnings, indicate "NONE" in the space provided. TO THE BOARD OF TRUSTEES: In accordance with the provisions of Title 3, Chapter 27, Section 711 (b) of the Virgin Islands Code (as extracted below) |, the undersigned do swear and affirm that while receiving my disability annuity, | earned $ in the calendar year from gainful occupation. Social Security No. — Name Date Signature a Street or P. QO. Box No. i City, State & Zip Code Extract from Title 3, Chapter 27, Section 711 (b). Virgin Islands Code: "Should any member receiving a duty disability annuity or non-duty disability annuity resume a gainful occupation, and his earnings therefrom together with his disability annuity exceed the rate of compensation of the member at the date of retirement, the Board shall reduce the amount of disability annuity to an amount which, when added to the compensation being carned by the member, shall not exceed the rate of compensation of the member at the date he last became a disability beneficiary." On this _day of | personally appeared before me the above named who is known to me and who subscribed the foregoing statement before me and made oath that the foregoing answers each and all complete and truc. (SEAL) NOTARY PUBLIC