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It collects retiree identification details, mailing and contact information, applicable benefit account selection, and the chosen withholding option. Options include no Colorado state tax withholding or withholding Colorado state tax, with marital status and an optional additional dollar amount. 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Please contact FPPA with any questions  \n* A copy that is compared to the original document and attested to by a notary  \n• Questions about completing this form?  \nCall Retiree Payroll at (303) 770-3772, ext. 6200 or (800) 332-3772, ext. 6200  \n• Return completed form to FPPA by one of the following ways:  \n• By mail to FPPA at 7979 East Tufts Avenue, Suite 900, Denver, CO 80237  \n• Email [to](to RetireePayroll@FPPAco.org)[ RetireePayroll@FPPAco.org](to RetireePayroll@FPPAco.org)  \n• Fax to 303-771-7622  \nAPPLICABLE BENEFIT ACCOUNT(S)  \nIf you receive more than one monthly pension benefit, please indicated which benefit account to apply this tax withholding change:  N/A  All Accounts  One Account Plan   Last Employer    \n\n| | Option\u003Cbr>A | I elect to have NO STATE TAXES WITHHELD. |\n| --- | --- | --- |\n| | Option\u003Cbr>B | COLORADO STATE TAX |\n|  |  | • Marital Status  Married  Single\u003Cbr>• Additional Amount (optional)\u003Cbr>$  (Dollar amount only. No percentages.) |\n\nIfyou are making this request as an Attorney-in-Fact under authority of a Power ofAttorney, you agree that by signing this document, you make the following representation: I represent to the Fire & Police Pension Association that I am the duly appointedAttorney-in-Fact and that such appointment has not been revoked by the principal.  \n    /   /    \nSignature of Retiree or Power ofAttorney Date  \nCSTW 11-23-2022  \nFor office use only","cbCaifKWjvsjO6sT","https://ap.wps.com/l/cbCaifKWjvsjO6sT","pdf",172916,"English","# Required Information\n## Retiree and Contact Details\n## Applicable Benefit Account(s)\n# Withholding Options\n## Option A: No State Taxes Withheld\n## Option B: Colorado State Tax\n## Marital Status and Additional Amount\n# Power of Attorney and Submission Instructions","[{\"question\":\"What information is required to complete the Colorado state withholding certificate?\",\"answer\":\"The form requests last name, first name, middle initial, SSN (last 4 digits), mailing address, email address, city, state, ZIP, and phone, plus selections for the applicable benefit account(s) and withholding option.\"},{\"question\":\"What are the two Colorado withholding options available on the form?\",\"answer\":\"Option A elects to have no Colorado state taxes withheld. Option B elects Colorado state tax withholding and includes marital status and an optional additional dollar amount.\"},{\"question\":\"What if the request is made under a power of attorney?\",\"answer\":\"A certified copy of the power of attorney documents must be included before the form can be processed, and the signatory agrees by signing that the appointment has not been revoked by the principal.\"}]","Colorado State Withholding Certificate for Pension or Annuity Payments - Monthly Pension Distributions | PDF",1789792627]