RETIRMENT ASSOCIATION
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PUBLIC EMPLOYEES RETIREMENT ASSOCIATION
CapItol Square BUIldIng
St Paul, MInnesota 55101
Telephone (612) 296-7460
Exhibit 28
APPLICATION FOR EXCLUSION FROM PERA MEMBERSHIP BY A CITY MANAGER
La~s 1981, Chapter 254, SectIon 1, defInes a CIty manager as follows:
". . . (l) a person duly appoInted to and holdIng the pOSl tlon of
CIty manager In a Plan B statutory CIty or In a home rule CIty oper-
atIng under the 'councIl-manager' form of government, or (2) a person
appoInted to and holdIng the posItIon of chIef admInIstratIve offIcer
of a home rule charter CIty or a statutory CIty pursuant to a charter
prOVIsIon, ordInance, or resolutIon establIshIng such a posItIon and
prescrIbIng ItS dutIes and responsIbIlItIes. "
I the undersIgned, a CIty manager as defIned, elect to be excluded from membershIp
In the PublIc Employees RetIrement AssocIatIon.
I ~lll not at any tIme In the future seek any authorIzatIon to purchase serVIce
credIt for any perIod of excludable serVIce and I understand that thIS electIon
IS Irrevocable
I became a CIty manager as defIned under Laws 1981, Chapter 254, for the CIty of
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SubscrIbed and sworn to before me thIS
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~day of
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Notary Publ1c of '0.~-)'lv"'.9-i v'
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~ ~~ J' SCOTT RENNE I
(Seal~~~!\J~ NOTARY PUBLIC MINNESOTA
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~ My CommlS;lon ExpireS Jan 30, 1987
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A COpy OF THE RE~OLUTION BY THE GOVERNING BODY OF YOUR CITY APPROVING
YOUR EXCLUSION FROM PERA MUST ACCOMPANY THIS FORM.
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