840 CMR 15.00: MISCELLANEOUS

15.01: Affidavit of Retired Members and Beneficiaries

(1) No less frequently than once every two years, each retirement board shall require each
member or beneficiary who receives a pension, retirement allowance, or survivor's allowance to
file with the retirement board an affidavit under the penalties of perjury, at such time and in such
form as the board shall prescribe, containing the following information:
      (a) the name of the member or beneficiary;
      (b) the current address of the member or beneficiary;
      (c) a statement certifying that the member or beneficiary is currently living;
      (d) a statement describing the beneficiary's current marital status where marital status
      is relevant to continued receipt of benefits;
      (e) a statement describing the beneficiary's current dependency status where dependency
      is relevant to continued receipt of benefits; and
      (f) such additional information as the board may require to determine whether the member
      or beneficiary is entitled to continued receipt of benefits.

(2) The retirement board shall withhold the retirement benefits of any member or beneficiary
who fails to file the affidavit within the time prescribed pending receipt of the affidavit. Upon
receipt of the affidavit, any benefits so withheld shall be paid to the retired member or
beneficiary.

(3) The retirement board may review and verify the accuracy of any affidavit submitted and
shall audit a random sample of at least five per cent of the affidavits received.

8/27/04

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