FIVE PERCENT SALARY OPTION
STATE OF MAINE
BUREAU OF HUMAN RESOURCES

NAME	SOCIAL SECURITY #
	
DEPARTMENT	CLASS TITLE

Eligible Employees:  The five percent salary option offered below is available to Physicians on the physicians’ salary schedules in accordance with Chapter 147, Part D, Section 3, Private and Special Laws 1975, as amended by Public Law 1989, Chapter 501, Part P, Section 33.

NOTE 1: For more information, see Human Resources Memorandum 7-94.

I understand that I must be a member of the Maine State Retirement System and that I must elect one of the following benefit options at the time of appointment.  The benefit option elected will remain in effect for the duration of my appointment.

_____I elect the 5% salary premium for my classification, and to pay my own contribution to the Maine State Retirement System (currently 7.65%).

_____I elect to be paid from the base salary schedule for my classification, and to have the State pay a portion of my contribution to the Maine State Retirement System (currently that portion paid is 6.5% of 7.65%).	
Signature							Date

_____Employee Copy 	_____BHR Copy	_____MSRS Copy	_____Bureau of Accounts & Control Copy

PER 116       03/21