R-286 - 10/12/1980 - IMRF - Resolutions • MRF
- `faMt�`ITE(a►
E CAsAI T..
a 1..4K
Q ' ILLINOIS MUNICIPAL RETIREMENT Ew:n
100 S;.tith Vi.n.Atr Drive. C■■ca10. ItiinGis 6O6t6
OMITTED SERVICE CREDIT AUTHORIZATION
(See instructions on reverse side)
Lik%-nber tia•••a Stcial Security Numhtr i,lames E. Clark 360. 20•-91€89
r Aa:iiaS> Present Position
OS 650 Poplar Avenues Elmhurst, IL 60126 Insp for
er rtiame Employer Number
Ya7.la a of Oak Brook 69-033-4572
Certification by Authorized Agent •
i certify that earnings for the above named member shown in the following statement are in agreement with
the governmental unit's payroll records. •
Earnings Paid In Month of I 19 19 76 1 19 19_ 19
January , __ . 344.0Q L.
February 43E,,00 r _
March 448.00 143.00
Quarterly Total , I LI$ 0, O lZa 3.a'i,00
April j 139.00 644.Qt3
May
— 567. 805, / _
June 392.0Q . _609.Op
quarterly Total _i•
July 588.n 67T02 ) P
Augusta 414.00 _294.00
September 476.00 ._.30$,.Q0._
Quarterly Total i ),498.00 1,169.00.__,
October 539.00 1 I r
November 291Lea_ l _____J
December. •a •a .
__ Quarterly Total t 1,827-00
Grand Total ) •« s •e
•
Date ' Signature of Authorizg Agent
Resolution by Governing Body
WHEREAS, earnings for the above named member should have been but were not reported to the Illinois Municipal
Retirement Fund for participation for 1 years and 7 months:
RESOLVED. that it is the fining of this Village of Oa1c_Brn.41c -that:
Name of Governing Body
I. The member was employed in a position normally requiring the performance of duty during 600 hours or more per
year.during the years and months shown above:
2. None of the service of tin member during these years and months was in a probationary position of four months
or less;
3. The member is currently employed in a participating position:and
FURTHER RESOLVED, that the governing body agrees to accept the cbligation due IMRF for employer contributions with
interest thereon payable through suture employer oontributions and to accept the charges for employer and employee social
security taxes if such taxes have not been paid on the omitted service earnings.
FURTHER RESOLVED: that the authorized agent is hereby authore ed end dee led to lie a certified copy of this •
resolution and all other pertinent forms and documents with the Illinois Municipal Retirement Fund.
Certification by Clerk or Secretory of Governing Cody
I Marianne Lakosi'+_ ,the______Y31,kla ge _C7.erl:_-_ ____ _of
Name Clerk or Snc■•tary
Village of Oak Brook do hereby certify that I am the
___. •� Name of GovrrpmanWl Unit
keeper of its records and that the foregoing is a true and corrt:ct ec;w of a resolution duly adopted by its governing i
=body at a meeting held on the_ .t day of_....lei 0-,k):-:t._.. _.. 19:i.;:_. I
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