Local Leave Election Form

Local Leave Election Form
Full Name:*
Employee ID #:
Address*
Street Address Line 2
CityState
Zip
Cell Phone:*
Email:
example@example.com
As a retiring employee of Alief ISD, you may be eligible to receive Local Leave benefit from the District. This benefit will be distributed to you through one of the following options:
I am authorizing the District to direct payment for my Local Leave benefit to the following:
Option 1 – Direct Deposit
Same as Alief ISD Payroll
Please deposit into a new account provided below:
Name of Bank:
CheckingSavings
Routing #
Account #
If you elect to have your Local Leave paid to thorough direct deposit, you would be paid in one lump sum, payable as taxable income with all applicable taxes deducted from the check at the time of the distribution.
Option 2 - Alief ISD 403b Deferral Account
Your Local Leave may be directed to the Alief ISD 403(b) Deferral Account set up through VALIC. I understand that any amount that is over the 403(b) Contribution Limit (including amounts I have already contributed to a 403(b) in the same tax year) may be paid to me the following fiscal year.
Employee's Signature
Clear
Date*
MonthDayYear
Date
Should be Empty: