Application For Volunteer Emergency-Worker'S Survivors Pension (Vesp) Form (Page 2 of 2) in pdf

CV-0636-0803q

PART III — CERTIFICATION OF MUNICIPALITY (See “Special Instructions” below)

Name of Municipality:___________________________________________ PERS Location Number:________________

Certifying Officer:_____________________________________________ Phone: (_____)________________________

AREA CODE

Signature:___________________________________________________ Date:______/______/_______

YYYY

SPECIAL INSTRUCTIONS TO EMPLOYERS

If your municipality has had a volunteer emergency-worker die while performing volunteer duties since January 1, 2000,

and that volunteer has one or more survivors meeting the criteria of Chapter 134, P.L. 2002 described below, you should:

Confirm the eligibility of the survivor(s) for a VESP and have the municipal governing body adopt a res-

olution certifying to that eligibility.

Have this Application for Volunteer Emergency-Worker's Survivors Pension completed and certified.

The Division of Pensions and Benefits also requires that the municipality forward the documentation

required to certify the eligibility for VESP benefits. This would include:

a) the police and/or accident report and the death certificate — required in all cases;

b) the marriage certificate — required if there is a surviving spouse;

c) birth certificates — required for all dependent children;

d) school enrollment records for dependent children over 18 — only required if there is no surviv-

ing spouse;

e) evidence of disability for dependent children — only required if there is no surviving spouse;

financial evidence of dependency for dependent parent(s) — only required if there is no sur-

viving spouse or dependent children.

Forward the resolution, this completed application, and the documents identified in item 3, above, to the

Division within ten days of the resolution’s adoption to: VESP, Division of Pensions and Benefits, PO

Box 295, Trenton, NJ 08625-0295.

NOTE: Do not delay the submission of the resolution if this application or the collection of other required documenta-

tion has not been completed when the resolution is due at the Division of Pensions and Benefits.

ELIGIBILITY FOR VESP BENEFITS

Chapter 134, P.L. 2002, establishes a pension for the survivors of certain volunteer emergency workers who die in the per-

formance of volunteer duties on or after January 1, 2000. The volunteer must have been a member of a duly incorporated

voluntary fire company, first aid and emergency, or ambulance or rescue squad.

Survivors (dependents) of a volunteer firefighter, first aid worker, rescue squad worker, or emergency medical technician

include:

—

A widow or widower (who has not subsequently remarried);

—

Unmarried children (a) under the age of 18; (b) age 18 years of age or older while enrolled in a sec-

ondary school; (c) under the age of 24 and enrolled in a degree program at an institution of higher edu-

cation for at least 12 credit hours each semester; or (d) a disabled child at any age who is incapable of

self-support due to the disability;

—

Dependent parents (if there is no widow, widower, or eligible dependent children) who received at least

half of their support from the emergency worker during the twelve months preceding the death.

NOTE: If a survivor is also eligible for a monthly pension benefit due to the voluntary emergency worker's membership in

a New Jersey State-administered retirement system on the basis of other employment, that survivor is not also eligible for

the VESP.

Application For Volunteer Emergency-Worker'S Survivors Pension (Vesp) Form Page 2

Related Articles

Related forms

Related Categories