Mesa Firefighters Retiree Subsidy Authorization FormPlease enable JavaScript in your browser to complete this form.Mesa Firefighters FormThe United Arizona Firefighters Health Care Trust (UAFHCT) is a Voluntary Employees Beneficiary Association (VEBA) trust which is subject to very strict government regulations. In order to retain the tax advantages provided in a VEBA, retirees who join the Health Care Trust must meet the following: In addition, at the end of each year it is the members responsibility to fill out and submit the Important (Subsidy spending certification form. Failure to annually fill out the certification form will result in a 1099 being sent to the member for the taxes due on that years subsidy total.)Membership in an Arizona IAFF affiliateLocal *Select From List479 - Tucson Fire Fighters493 - United Phoenix Fire Fighters1234 - United Yuma Fire Fighters1505 - United Flagstaff Fire Fighters2146 - Bisbee Fire Fighters2260 - United Mesa Fire Fighters2273 - Globe Fire Fighters2763 - Nogales Fire Fighters2974 - Lake Havasu Fire Fighters3066 - United Yavapai Fire Fighters3449 - United Valley Fire Fighters3504 - United Pima Fire Fighters3572 - Northwest Fire Fighters3573 - Sun Cities Fire Fighters3647 - Bullhead City Fire Fighters3690 - Sedon/Verde Valley Fire Fighters3752 - Casa Grande Fire Fighters3832 - North Tucson Fire Fighters3878 - United Maricopa Fire Fighters3924 - Avondale Fire Fighters4005 - Goodyear Fire Fighters4125 - Green Valley Fire Fighters4135 - North Gila Co Fire Fighters4191 - United Kingman Fire Fighters4217 - White Mountain Fire Fighters4295 - Mohave Valley Fire Fighters4311 - United Buckeye Fire Fighters4324 - Ft Mojave Fire Fighters4361 - Northwest Valley Fire Fighters4371 - United West Valley Fire Fighters4462 - West Valley Fire Fighters4492 - Sierra Vista Fire Fighters4512 - Florence Fire Fighters4518 - Tri-City Fire Fighters4543 - Desert Hills Fire Fighters4561 - Professional Fire Fighters of Maricopa4596 - Eloy Fire Fighters4631 - Rio Rico Fire Fighters4651 - Wickenburg Fire Fighters4677 - Harquahala Fire Fighters4729 - Page Fire Fighters4913 - Fry Fire Fighters4944 - Old Pueblo Fire Fighters5050 - Scottsdale Fire Fighters5100 - Vail Fire Fighters5256 - Professional Fire Fighters of WhetstoneN/ADepartmentParticipant Name *Social Security Number *Address *City *State *Zip *Email *Home Phone *Mobile Phone *Date of Retirement *How do you want the funds distributed? *Direct DepositMail to my address aboveName on Bank Account RegistrationBank NameBank Routing (ABA) NumberBank Account NumberCommentsSignature Clear Signature Date / TimeDateTimeSubmit
