The Montana 1024 form is an application for pension benefits under the Volunteer Firefighters’ Compensation Act (VFCA). This form is essential for volunteer firefighters seeking to secure their pension benefits after meeting specific service and age requirements. Completing the Montana 1024 form correctly ensures that you receive the benefits you’ve earned for your dedicated service.
The Montana 1024 form serves as a crucial document for volunteer firefighters seeking pension benefits under the Volunteer Firefighters’ Compensation Act (VFCA). This application outlines the eligibility criteria, benefit structures, and procedural steps necessary for securing retirement compensation. To qualify, firefighters must meet specific service requirements, including a minimum of 20 years of credited service and the age of 55 for full benefits. The base pension starts at $150 per month, with potential increases based on additional years of service. Importantly, individuals may also retire with a partial pension after completing at least ten years of service, although certain restrictions apply once benefits are initiated. The application process includes vital components such as survivor information, direct deposit elections, and tax withholding options. Ensuring that all required documents are submitted accurately is essential, as incomplete applications may be returned. The form not only facilitates the pension application but also provides essential information regarding the management of benefits, including direct deposit procedures and tax implications.
Montana Public Employee Retirement Administration
PO Box 200131 • Helena MT 59620-0131
(406)444-3154 • Toll Free (877) 275-7372 http://mpera.mt.gov
VOLUNTEER FIREFIGHTERS’ COMPENSATION ACT (VFCA)
APPLICATION FOR PENSION BENEFITS
Dear Volunteer Firefighter:
Thank you for your service as a volunteer firefighter! The following information includes instructions for completing your Application for Pension Benefits as well as information regarding the terms and conditions of receiving your benefit. Please carefully read the following information, complete the application and return it to the Montana Public Employee Retirement Administration (MPERA) at the address shown above.
Important Information About Your VFCA Benefits
If you meet the service or age requirements, you do not need to be an active member of a fire company when you apply for pension benefits. However, you may not continue to be an active member of any fire company once you start receiving a pension benefit.
You are eligible to receive a full pension benefit after completing at least 20 years of credited VFCA service and reaching age 55. You will receive the full pension benefit for your lifetime. Your base pension monthly benefit will be $150 per month.
For each year of credited service beyond 20 years, and up to 30 years, your benefit will increase by $7.50 per month.
For each year of service beyond 30 years, your benefit may increase an additional $7.50 per month. Eligibility for this additional benefit will be determined annually, based on the pension trust fund being actuarially sound and amortizing within 20 years or less. (This additional benefit applies only if you retire on or after July 1, 2011.)
You can retire with a partial pension benefit after completing at least ten years, but less than 20 years, of credited VFCA service and reaching age 60.
(§§ 19-17-401, 19-17-404, MCA)
Benefit Payment Information
Pension benefits are sent on the last working day of the month and are subject to state and federal taxes.
If you choose to retire and receive a monthly pension benefit, you must sign and return your completed retirement application to MPERA at least 30 days prior to your anticipated retirement date. Please include a:
Copy of your certified birth certificate
A voided check (if you elect direct deposit)
Form 1024
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Step 1: Complete Your Survivor Information
A survivorship benefit may be paid to your spouse or a dependent child. A dependent child is under 18 years of age, and is unmarried. Monthly benefits paid to a survivor will equal the member's full or partial pension benefit or disability benefit.
Survivorship benefits are limited to 40 months, including any benefit paid to the member before death. If a member receives benefits for 40 months, no survivorship benefit is available. At the request of the survivor, a lump sum payment for the survivorship benefit may be made instead of the monthly benefit payments.
Step 2: Direct Deposit Election
We are pleased to offer you the safety and convenience of direct deposit of your monthly benefit payment. You must complete this section of your Application for Pension Benefits to authorize MPERA to send your monthly payment to the identified financial institution for deposit in your account. The financial institution may be any bank, savings bank, savings and loan association or similar institution, or federal or state chartered credit union located in the U.S.
Forms received by the 15th of any month will be processed that month. Your payment will be electronically deposited into your bank account on the last business day of each month. MPERA will not send a separate notification that your payment has been deposited, unless the net amount of the payment changes.
SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS
Joint account holders should immediately advise both MPERA and the financial institution of the death of the payee. Payments deposited after the date of death must be returned to MPERA. A determination regarding any death benefit payable will be made by MPERA.
CANCELLATION
The direct deposit of your payment will continue until you notify MPERA, in writing, that you wish to change your account, or upon notification of your death. If you wish to change financial institutions, contact MPERA for a new Direct Deposit Agreement. If changing accounts, do not close your existing account until a payment has been deposited into your new account.
The financial institution may also cancel this agreement upon notification to you, the payee. Please notify MPERA if this occurs.
COMPLETING YOUR DIRECT DEPOSIT ELECTION -- PAYEE CERTIFICATION
By completing the information on the Application for Pension Benefits, I am requesting that MPERA directly deposit my payment from the identified retirement system to the identified financial institution. I certify that I am entitled to payment from the retirement system identified above; I have identified all joint account holders; and I authorize MPERA to make necessary adjustments to my account to collect deposits made in error.
If your payment is to be deposited into your checking account, attach a voided check. If it is to be deposited into your savings account, provide the routing number. Please note: MPERA cannot make direct deposits to banks outside the U.S.
Page 2 of 6
Step 3: Choose Your Tax Withholding
MPERA will not withhold federal and state income taxes from your pension benefit unless you elect withholding. Please select only one option for your federal and state income taxes.
Step 4: Required Documents and Signatures
This step must be completed or your application will be returned. Please include all of the required documents. All signatures must be witnessed by a non-beneficiary third party.
Page 3 of 6
VOLUNTEER FIREFIGHTER COMPENSATION ACT
MEMBER INFORMATION
Name - Last
First, MI
Social Security Number*
-
Date of Birth
Fire Company You Are Retiring From
/
Mailing Address
City
State
Zip Code
Daytime Phone Number
Email Address
(
)
Last Credited Year of Service
Date of Retirement
Assuming all eligibility requirements have been met, your effective date of retirement will be the first day of the month following your termination. You may specify a later date. However, your retirement date cannot be earlier than the date you meet retirement eligibility.
SPOUSE INFORMATION
Last Name
First Name, MI
DEPENDENT CHILDREN (required only if there is no spouse)
Gender
M
F
M
F
*For identification and tax purposes. §19-2-403(7) MCA, 26 USC § 6041A and 6109
Page 4 of 6
Direct Deposit Election
RETIREE INFORMATION
I request that MPERA deposit my payment into my account at the financial institution identified below. I certify that I am the account holder of this account and I have identified all joint account holders. I authorize MPERA to make necessary adjustments to my account to collect deposits made in error.
Retirement Number (leave blank if unknown)
Retirement System
()
Signature
FINANCIAL INSTITUTION INFORMATION
MPERA cannot make deposits to banks outside the U.S.
Name of Financial Institution
Phone Number
Account Type
Account Number
Routing Number
Checking
Savings
JOINT ACCOUNT HOLDER INFORMATION (if applicable)
I certify by signing this Application for Pension Benefits that I understand my responsibilities as a joint account holder to immediately advise both MPERA and the financial institution of the death of the payee and that payments deposited after the date of death must be returned to MPERA. I also understand providing false information or improperly receiving payment may be a criminal offense under Montana and federal law.
Attach a voided check here if checking account (do not staple).
Please do not attach a deposit ticket.
Page 5 of 6
Tax Withholding
Federal Income Tax information. Please choose only one.
Do not withhold federal income tax.
Withhold federal income tax in the amount of $__________ per month.
Withhold federal income tax based on the tax tables for:
A married individual with _______ tax withholding exemptions.
A single individual with _______ tax withholding exemptions.
In addition to the amount withheld, withhold $_________ per/month.
State Income Tax information. Please choose only one.
Do not withhold State of Montana income tax.
Withhold State of Montana income tax in the amount of $__________ per/month.
Withhold State of Montana income tax based on (#) __________ of exemptions.
In addition to the amount withheld, withhold $_________ per/month.
Required Documents and Signatures
I have enclosed a copy of my certified birth certificate
I authorize one of the following:
I elect direct deposit.
I elect to receive paper checks by mail.
REQUIRED SIGNATURES
I certify that the information submitted herein is true and correct to the best of my knowledge. I understand to cancel this application I must notify MPERA in writing before I cash or receive my first monthly pension benefit.
I also certify that I have read and understand all of the information provided with this application.
Your Signature
Date
/ /
I certify that this individual has terminated service with the named fire company or will terminate service as of the designated date.
Name of Fire Chief
Fire Chief Signature
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