Retirement Notice Template For State Employees

State employees submit an irrevocable notice to their supervisors to announce their planned retirement.

Download the Form


  • Edit the memo header:
    • Your supervisor's name
    • Your name
    • Current Date
  • Edit the memo body:
    • Effective retirement date (day after your last day on the payroll)
    • Your last day at work (last day on the payroll)
  • Add your person number
  • Sign and date the memo
  • Make a copy for your records
  • Submit your notice  to your supervisor
  • Submit your notice to Human Resources

Human Resources
University at Buffalo
Townsend Hall
205 Hayes Road
Buffalo, NY 14214

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Do not submit your notice unless you are certain the dates are correct. Contact a retirement expert if you want verification of your calculation.

Need Help Completing the Form?

Lissa Jasinowski.

Lissa Jasinowski

Assistant Director

Benefits and Work Life Balance

Phone: (716) 645-4488


Form Facts

Form Type: Downloadable, Microsoft Word document

Requirements: Microsoft Office Word

Updated: 9/2015

Owner: State Benefits, Human Resources