413.3E2 - Classified Employee Severance Plan Beneficiary Designation

In the event of the death of the employee prior to payment of the early retirement plan, but after the employee’s retirement has begun, the payment will be paid to the designated beneficiary in one lump sum payment.  In the event no beneficiary is designated, the payment will be paid to the employee’s estate in one lump sum payment. 

Pursuant to the provisions of board policy 413.3, I hereby designate my beneficiary to be:

 

                        Name: _____________________________________________________

                    Address: ______________________________________________________

         City, State, Zip: ______________________________________________________

                  Signature: ______________________________________________________

    Witness Signature: ______________________________________________________

                         Date: ______________________________________________________