[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-306046-105":53,"doc-detail-306046-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","make-up-buyback-application-form-member-service-purchase-credit","Make-Up Buyback Application Form - Member Service Purchase Credit","","Make-Up Buyback Application Form for the Salem Contributory Retirement Board to purchase creditable service for which retirement contributions were not previously withheld. The form collects member details, the type and description of buyback time, and a member statement with signature and date. A second section gathers service information from the employer, including start/end dates by calendar year and earnings details, then requires a payroll official statement, signature, name, and title for verification.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/make-up-buyback-application-form-member-service-purchase-credit/306046/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/make-up-buyback-application-form-member-service-purchase-credit/306046.png","ImageObject",442,249,{"name":88,"@type":89},"Quinn","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-12","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"Who should complete Part 1 of the Make-Up Buyback Application Form?","Question",{"text":109,"@type":110},"The member completes Part 1, including member information, buyback time details, and the member statement and signature with date.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What information does the employer complete in Part 2?",{"text":114,"@type":110},"The payroll department completes Part 2 by providing service information such as start and end dates by calendar year, hours worked, hourly rate, and regular gross earnings.",{"name":116,"@type":107,"acceptedAnswer":117},"How can the member pay for the buyback time?",{"text":118,"@type":110},"Payment can be made as a lump-sum payment or through a transfer of funds from another eligible retirement plan.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},306046,1790434832,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},962075114765,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","| | Salem Contributory Retirement Board\u003Cbr>20 Central Street, Suite 110\u003Cbr>Salem, MA 01970\u003Cbr>Phone number (978) 745-8983 * Fax number (978) 745-4216 |\n| --- | --- |\n| Make-Up Buyback Application Form\u003Cbr>Please complete this form if you wish to purchase creditable service for which contributions were not previously withheld. Please complete Part 1, then have the payroll department where the service was rendered complete Part 2. You may pay for this time in a lump-sum payment, or through a transfer of funds from another eligible retirement plan. |  |\n| Part 1\u003Cbr>Section 1 – Member Information\u003Cbr>Name  SS\\# XXX-XX- Address  City  State  Zip Code  Home Phone(  )   -   Cell Phone(  )   -  E-mail  Unit Currently Employed By______________________________________________________\u003Cbr>Section 2 – Buyback Time to purchase\u003Cbr>\u003Cbr>  Call Firefighter   Permanent Intermittent\u003Cbr>\u003Cbr>  Dispatch    Make-Up (seasonal, provisional, temporary)\u003Cbr>\u003Cbr>  Other Please describe \u003Cbr>Section 3 – Statement and Signature by Member\u003Cbr>I hereby apply to purchase the indicated time above. I certify under the penalties of perjury that the information I have provided on this application is true and accurate.\u003Cbr>Applicant’s Signature  Date  |  |\n\n\n| | Salem Contributory Retirement Board\u003Cbr>20 Central Street, Suite 110\u003Cbr>Salem, MA 01970\u003Cbr>Phone number (978) 745-8983 * Fax number (978) 745-4216 |\n| --- | --- |\n| Part 2\u003Cbr>Section 4 – Service Information (to be completed by employer where service was rendered but retirement contributions were not withheld)\u003Cbr>Start Date* to End Date* Hours Worked Hourly Rate Regular Gross Earnings\u003Cbr>of service of service per calendar year\u003Cbr>*(Report start/end date by calendar year only)\u003Cbr>____________\u003Cbr>____________\u003Cbr>____________\u003Cbr>\u003Cbr>____________\u003Cbr>____________\u003Cbr>____________\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>\u003Cbr>Member’s Job Title \u003Cbr>Section 5 – Statement and Signature by Payroll Official\u003Cbr>I certify that the information I have provided above is true and accurate.\u003Cbr>Signature  Date  Name  \u003Cbr>Title   |  |\n| Clear\u003Cbr>Print\u003Cbr>|  |","cbCaiiMYJl4bKEjv","https://ap.wps.com/l/cbCaiiMYJl4bKEjv","pdf",181377,"English","# Part 1 - Member Information\n## Section 1 – Member Information\n## Section 2 – Buyback Time to Purchase\n## Section 3 – Statement and Signature by Member\n# Part 2 - Service Information and Employer Certification\n## Section 4 – Service Information\n## Section 5 – Statement and Signature by Payroll Official","[{\"question\":\"Who should complete Part 1 of the Make-Up Buyback Application Form?\",\"answer\":\"The member completes Part 1, including member information, buyback time details, and the member statement and signature with date.\"},{\"question\":\"What information does the employer complete in Part 2?\",\"answer\":\"The payroll department completes Part 2 by providing service information such as start and end dates by calendar year, hours worked, hourly rate, and regular gross earnings.\"},{\"question\":\"How can the member pay for the buyback time?\",\"answer\":\"Payment can be made as a lump-sum payment or through a transfer of funds from another eligible retirement plan.\"}]","Make-Up Buyback Application Form - Member Service Purchase Credit | PDF",1789832334]