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Form SC-04 <br /> <br /> Deferred Member Information (fully or partially vested) <br /> See separate instructions regarding completion of the fields below. <br /> <br />ELK RIVER <br /> <br />/ Page 2 <br /> <br />Total Service: <br /> <br />2004 Estimated Liability: <br /> <br />2005 Estimated Liability: <br /> <br />Enter all information as it pertains to this member. <br /> <br /> Member Name: <br /> <br /> Vesting: Minimum Years Required: 5 <br /> <br /> Deferred Interest (if offered): Calendar Year <br /> <br /> Service Dates: Entry: 2/1/1981 Separation: <br /> <br /> LOAs (in months): 0 <br /> <br /> Years: 20 Months (if paid): 0 <br /> 77,920 <br /> 81,816 <br /> <br /> Benefit Level <br /> at Separation: <br /> <br />DOB: <br /> <br />X OR FullPeriod <br /> <br />2/1/2001 <br /> <br />Vesting <br />Percent: 100 % <br /> <br />(overwrite, if necessary) <br /> <br /> Are Months of <br />3,575 Service Paid? Yes <br /> <br />Interest Option in Bylaws at Separation * <br /> <br /> (Choose one option) D <br /> A - No Interest <br /> B - Straight 5% <br /> C - Separate Account/Vehicle <br /> D - Actual interest, up to 5% <br /> <br />* Since interest option D was chosen, enter the rates of return used for each year below. <br /> <br />1980: % 1985: % 1990: % 1995: <br />1981: % 1986: % 1991: % 1996: <br />1982: % 1987: % 1992: % 1997: <br />1983: % 1988: % 1993: % 1998: <br />1984: % 1989: % 1994: % 1999: <br /> <br />+This rate of return is calculated using <br /> <br />the earnings projected on Page 3 of the Schedule. <br /> <br />% 2000: % <br />% 2001: o.oo% <br />% 2002: o.oo % <br />% 2003: 5.oo% <br />% 2004: 3.79 % + <br /> <br />Enter all information as it pertains to <br /> <br /> Member Name: <br /> <br /> Vesting: Minimum Years Required: <br /> <br />this member. <br /> <br />Benefit Level <br />at Separation: <br /> <br />5 DOB: 11/27/1958 <br /> <br />Deferred Interest (if offered): <br /> <br />Service Dates: Entry: <br /> <br />Total Service: <br /> <br />2004 Estimated Liability: <br /> <br />2005 Estimated Liability: <br /> <br /> Calendar Year X OR FullPeriod <br /> <br /> 10/1/1981 Separation: 1/31/2004 <br /> <br /> LOAs (in months): 12 <br /> Vesting <br />Years: 21 Months (if paid): 4 Percent: 100 % <br /> <br /> 76,267 (overwrite, if necessary) <br /> 80,080 <br /> <br />Are Months of <br />Service Paid? Yes <br /> <br />Interest Option in Bylaws at Separation * <br /> <br /> (Choose one option) D <br /> A - No Interest <br /> B - Straight 5% <br /> C - Separate Account/Vehicle <br /> D - Actual interest, up to 5% <br /> <br />* Since interest option D was chosen, enter the rates of return used for each year below. <br /> <br />1980: % 1985: % 1990: % 1995: <br />1981: % 1986: % 1991: % 1996: <br />1982: % 1987: % 1992: % 1997: <br />1983: % 1988: % 1993: % 1998: <br />1984: % 1989: % 1994: % 1999: <br /> <br />+This rate of return is calculated using the earnings projected on Page 3 of the Schedule. <br /> <br />% 2000: % <br />% 2001: % <br />% 2002: % <br />% 2003: % <br />% 2004: 3.79%+ <br /> <br /> <br />