SAUGUS PUBLIC SCHOOLS
Teacher Matching 403B Form
FY’__
Please complete and submit to Superintendent’s Office by June 1.
Date:____________________________________
Superintendent
Saugus Public Schools
23 Main Street
Saugus, MA 01906
Dear Superintendent:
I am requesting the matching amount of $600.00 for my 403B account as per the SEASSC Contract. I was hired after September 1, 1999.
(This form must be completed each year to qualify for the match.)
Please issue the funds to the _________________________________________account.
Name of 403B Fund Account
Thank you for your attention to this matter.
Teacher’s Name:_________________________________________________________
Please Print Name
School:_________________________________________________________________
Eligibility Confirmed by:


Superintendents Office_________________
Payroll___________ Date:_____________
Signature:_________________________________________________________________________
Executive Director of Finance and Operations
cc: Payroll