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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 / Page 2a <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 /> Member Name: <br /> <br /> Vesting: Minimum Years Required: 5 DOB: <br /> <br /> Deferred Interest (if offered): Calendar Year X OR <br /> <br /> Service Dates: Entry: 8/1/1983 Separation: <br /> <br /> LOAs (in months): 6 <br /> <br /> Years: 15 Months (if paid): <br /> 34,993 <br /> 34,993 <br /> <br />Benefit Level <br />at Separation: <br /> <br /> Full Period <br /> <br /> 3/3/1999 <br /> <br /> Vesting <br />1 Percent: 80 % <br /> <br />(overwrite, if necessary) <br /> <br /> Are Months of <br />2,900 Service Paid? Yes <br /> <br />Interest Option in Bylaws at Separation <br /> <br /> (Choose one option) A <br /> A - No Interest <br /> B - Straight 5% <br /> C - Separate Account/Vehicle <br /> D - Actual interest, up to 5% <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 />% 2000: 0.00% <br />% 2001: 0.00% <br />% 2002: 0.00% <br />% 2003: 0.00% <br />0.00% 2004: %+ <br /> <br />+This rate of return is calculated using the earnings projected on Page 3 of the Schedule. <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: 9/1/1989 <br /> <br /> LOAs (in months): <br /> <br /> Years: 6 Months (if paid): <br /> 6,549 <br /> 6,549 <br /> <br />Benefit Level <br />at Separation: 2,350 <br /> <br /> DOB: <br /> <br /> X OR FullPeriod <br /> <br />Separation: 1/1/1996 <br /> <br /> Vesting <br />4 Percent: 44 % <br /> <br />(overwrite, if necessary) <br /> <br />Are Months of <br />Service Paid? Yes <br /> <br />Interest Option in Bylaws at Separation <br /> <br /> (Choose one option) A <br /> A - No Interest <br /> B - Straight 5% <br /> C - Separate Account/Vehicle <br /> D - Actual interest, up to 5% <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 />% 2000: 0.00% <br />0.00% 2001: 0.00% <br />o.00% 2002: 0.00% <br />o.oo% 2003: o.oo % <br />0.oo% 2004: %+ <br /> <br />+This rate of return is calculated using the earnings projected on Page 3 of the Schedule. <br /> <br /> <br />