*+587* TEACHER RETIREMENT SYSTEM OF TEXAS 1000 Red River Street, Austin, Texas 78701-2698 Telephone (512) 542-6400 or 1-800-223-TRST (8778) www.trs.state.tx.us TRS 587 09-09 CERTIFICATION of UNUSED STATE SICK and/or PERSONAL LEAVE Member's Name Social Security Number Employer The certification below must be completed by the TRS-reporting official at the school district where you are currently employed. An eligible member of the Teacher Retirement System (TRS) may establish one year of equivalent membership service credit for 50 or more days or 400 or more hours of unused state sick and/or personal leave. No more than 5 days per year may be accumulated toward this requirement; therefore, a member must have at least 10 years of active TRS membership credit for service actually rendered in Texas public schools. This service may only be purchased at the time a member retires. Payment in full must be received by TRS no later than the member's effective date of retirement or the last day of the month in which the member's retirement application is filed, whichever is later. In either case, however, payment must be received within the plan year in which the member retires. Credit for unused state sick and/or personal leave may be established by depositing with the System the actuarial present value, at the time of deposit, of the additional standard retirement annuity benefits that would be attributable to the conversion of the unused leave into service credit based on rates and tables adopted by the Board of Trustees of the System. This certification form will not be accepted at TRS more than 30 days prior to the effective date of your retirement. If you purchase this service credit and subsequently revoke your retirement, your payment will be refunded to you and the service credit will be removed from your record. Number of days or hours of accrued unused state* sick and/or personal leave: * Count state leave only. Do not count locally granted leave. days/hours (circle one) I certify that the person named on this form has the accrued unused sick and/or personal leave stated above as of , 20 and that no more than 5 days accrued in any school year. Signature of TRS-Reporting Official Title Printed Name of TRS-Reporting Official Date .
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