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Application for Lump Sum (De minimis) Retirement Distribution

About this Form

Form number: 455-26

Audience:  MCPS Staff

Last revised: November 2021

INSTRUCTIONS: Complete this form 30 days prior to effective date of retirement, and return to the Employee and
Retiree Service Center.

Adobe PDF Application for Lump Sum (De minimis) Retirement Distribution72 KEnglish

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