407.6E3 - Designation of Beneficiary

If the Board approves my application for early retirement benefits and I die before I receive the Benefit, I direct the Board to pay the Benefit to:

 

 ___________________________________________
  Name of Beneficiary

___________________________________________
  Street Address

___________________________________________
  City, State, Zip

___________________________________________
  Telephone

 

 

 

 

 

Print Full Name _________________________________________________

 

Signed:  _____________________________________________     Date __________________________