457(b) SRA Form Fayette County

Fayette County 457(b) DEFERRED COMPENSATION PLAN
Salary Reduction Agreement*

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Name*

First NameMiddle NameLast Name
Date of Birth*

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Email*
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Address

Street Address

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1.) I am requesting salary reduction to begin on paycheck date noted below:
Effective Date Of Salary Reduction*

MonthDayYear
Contribution Start Date
2.) Investment Vendor Choice: Lincoln Investment 3.) Salary Reduction Amount - I request to defer the following amount from eligible compensation as an elective deferral in accordance with and subject to the IRS rules and regulations:
Choose to contribute as percentage (%) or dollar amount ($) of your compensation:*

As percent (%) of my compensationAs dollar amount ($) of my compensation
First Pay Period of Month as %:*
Enter Amount as % (percent) of my eligible compensation, per pay period
First Pay Period of Month as $:*
Enter Amount as $ (dollar amount) of my eligible compensation, per pay period
Second Pay Period of Month as %:*
Enter Amount as % (percent) of my eligible compensation, per pay period
Second Pay Period of Month as $:*
Enter Amount as $ (dollar amount) of my eligible compensation, per pay period
I authorize Fayette County to remit the salary reduction amounts designated above to the designated investment company as contributions to the Fayette County 457(b) Employee Retirement Plan, an IRC §457(b) plan and I acknowledge the following:

• This agreement will take effect the month following the month in which the form is signed and dated below.
• This agreement will remain in effect until the employee notifies the Fayette County, in writing, to change or discontinue deferrals, or Fayette County terminates or modifies this agreement, at any time, to comply with applicable laws or for any other reason in its sole discretion.
• Fayette County does not warrant the performance or the appropriateness of any investment or the tax consequences and will not be responsible for any penalties or tax consequences resulting from this agreement.
• The Plan limits withdrawals, except after reaching age 70½, while employed at Fayette County.
• I am aware of the fees and expenses charged by the designated investment company and I authorize Fayette County to release or obtain from my vendor any information that may be reasonably required to calculate contribution limits or to administer the Fayette County 457(b) Employee Retirement Plan.
• The Internal Revenue Service imposes various limits on contributions to, or benefits from, different retirement plans. In addition, some limits require aggregation of the Fayette County 457(b) Employee Retirement Plan with other plans in which I may participate. These rules may vary depending on the type of plan, the type of contributions, and how the plan is structured. Fayette County does not monitor your participation in other plans.
INTERNAL REVENUE CODE CONTRIBUTION LIMITS
Annual Dollar Limit on Elective Deferrals (IRC §457(b)(2))
Internal Revenue Code (IRC) §457(b)(2) limits the amount of salary deferral contributions that can be contributed to the Fayette County 457(b) Employee Retirement Plan and to all IRC §457(b) plans and other similar type of plans in which an employee participates in any calendar year. The annual dollar limit is the lesser of 100 percent of the employee’s compensation for the calendar year, or the “applicable dollar amount” which is $22,500 in 2023. An employee must self-monitor elective deferrals made to any other current or former employer retirement plans, to avoid exceeding the IRC limits.

Age 50 or Older Catch-up Contributions (IRC §414(v)(2))
For participants who are at least age 50 before the end of the plan year, the current dollar limits on elective deferrals are increased. The additional elective deferrals that are permitted to be made by an eligible participant is the lesser of the participant’s compensation for the year reduced by any other elective deferrals of the participant for the year or the “applicable dollar amount” which is $7,500 for 2023.

Special 3-year Plan Catch-Up Limitation
If the applicable year is one of an Employee’s last 3 calendar years ending before the Participant attains Normal Retirement Age, the Employee may be eligible for additional deferrals. Consult the Plan Representative or Plan Document for additional information.

Fayette County cannot give tax advice. If you have questions about how tax law may affect your tax situation, please consult a tax advisor.
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Date*

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Fayette County 457(b) DEFERRED COMPENSATION PLAN