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1-i1=1-'I~iOVHL DI'~ HF'F-'L1L:H~7~lUlV FOIL h+lll_ lFa li t' -~~ ~~ ~--~
On tt~;is the ::3rd day of F'na~ust 1~`~~+, ~-t{;on motion m~ide [;y
Commissioner' Gehler, secancfed by Commissioner i-ehman, the
t~ouu~~t unanimously approved by a vote of 3-~-@, to ~:rpprove the
applicciion form rc;r military sE:•r~vice fii'r Oary (i. Ct-~apaia;~ i-crr
cr-etiiteci service wtti~~; the amount in be paid being w3ur+.klv'I from
Line li F:•m i~Io. i~11--S t._.-aJ:;, Jail het ircmBnt.
COMMISSIONERS' COURT AGENDA REQUEST
• PLEASE FURNISH ONF ORIGINAL AND FI VF rOPI OF THIS R 0 5T AND DO M NTS
TO BE R VIEW D BY THE .0 1RT.
MADE BY: BARBARA NEMEC TREASURER
OFFICE:
MEETING DATE: AUGUST 23, 1994 TIME PREFERRED: A. M.
SUBJECT: (PLEASE BE SPECIFIC): CONSIDERATION OF APPLICATION FOR
MILITARY SERVICE CREDIT FOR GARY R. CHAPMAN
EXECUTIVE SESSION REQUESTED: PLEASE STATE REASON
ESTIMATED LENGTH OF PRESENTATION: 2 MIN.
1F PERSONNEL MATTER -NAME OF EMPLOYEE:
NAME OF PERSON ADDRESSING THE COURT: _ BARBARA NEMEC, TREASURER
Time for submltting this request for Court to assure that the matter is posted in
accordance with Article 6252-i7 is as follows:
• Meetings held on Tuesday: 12:00 P. M. previous Wednesday
THIS REQUEST RECEIVED BY:
THIS REQUEST RECEIVED ON:

Ail Agenda Requests will be screened by the County Judge's Office to determine 1
adequate Information has been prepared for the Court's formal consideration and action a
time of Court meetings. Your cooperation will be appreciated and contribute toward:
your request being addressed at the earliest opportunity. See Agenda Request Guidelines.
p\Si AI(j9
~~ ~P~
m
'~ 5 TCDRS-36
~dk31 WjvS~
APPLICATION FOR MILITARY SERVICE CREDIT
Name t'ARY R CHAPMAN Membership No. 232-203 _ _
Subdivision KERR COUNTY Date AUGUST 23,_1994
Application for Current Service Credit for Military Service should be completed and submitted only if the follow-
ing requirements are met:
(a) The applicant was relieved from active military service under conditions other than dishonorable.
(b) The applicant is not and will not receive military retirement benefits provided by any federal law or reg-
ulation or federal retirement Act for at least twenty (20) years active duty.
(c) The applicant is not and will not be granted credit by any other retirement system or program estab-
lished or governed by the laws of this State for the same military service for which credit is being sought
with the Texas County and District Retirement System.
(d) The applicant's military service was active military service during the period from April 6, 1917 to
November 11, 1919, or from October 16, 7940 to October 31, 1974.
(e) The applicant must be a member of the Texas County & District Retirement System. If applying for mil-
itary service credit of three (3) years or less, the applicant must have been employed at least ten (10)
years by the participating subdivision and have at least ten (10) years retirement credit as an employee.
if applying for military service credit of more than three (3) years but not more than five (5) years, the
applicant must have been employed at least fifteen (15) years by the participating subdivision and have
at least fifteen (15) years retirement credit as an employee.
(f) The application must be accompanied by the applicant's contribution and the subdivision's matching
contribution (as calculated below).
CALCULATION OF AMOUNT TO BE PAID:
(1) Total months of creditable service with this subdivision as of
date of application
(2) Total number of months in military service for which credit is
being purchased
(3) Average monthly deposit during first year of TCDRS membership
(not to exceed $15.00)
(4) Amount to be paid by member
(Multiply line (2) byline (3) )
(5) Amount to be paid by subdivision
(Same as line (4) )
(6) Total amount to be paid
(Total of lines (4) and (5) )
CERTIFICATION BY MEMBER:
22
$_ 15.00
$ ~3.p_On
g 330.00
$ 660.00
1 certify that I understand the requirements for military service credit as set forth in items (a) thru (f) above and that I
am qualified to receive such credit with the Texas County & District Retirement System.
i
' % ~
i
/ % Signature ff Mek
CERTIFICATION BY AUTHORIZED COUNTY OR DISTRICT OFFICIAL:
I certify that I understand the requirements for military service credit as set forth in items (a) thru (f) above and that
in my opinion the above named applicant is qualified to receive such credit with the Texas County & District
Retirement System. I further certify Xhat the tota{ amount to be paid of $ (line (6)) is
correct.
Subdivision Official's Signature and Title
NOTE: Please do not send supporting documents such as military discharge papers, payroll records or creditable
service information in that the review of such documents should be effected by the County or District official
whose signature appears on this form.
O~~ NO, 22221
OF ~~'I~ COY R
~LIT~Y SESZ~C~
g, CH
Ault 23r 1994
i
ik
6
St
t
_„ S43